Clinical Utility of the Death Literacy Index in Canada: A Mixed-Methods Study

Area of Science:

• Palliative Care
• Health Education
• Sociology of Death

Background:

• End-of-life education programs necessitate standardized tools for assessing knowledge gaps and evaluating effectiveness.
• The Death Literacy Index (DLI) is a potential instrument for measuring death literacy, a concept encompassing knowledge, attitudes, and skills related to end-of-life care.

Purpose of the Study:

• To examine the perceived clinical utility and acceptability of the Death Literacy Index (DLI) within the Canadian healthcare context.
• To identify areas for improvement in the DLI based on feedback from end-of-life care stakeholders.

Main Methods:

• A mixed-methods approach was employed, combining quantitative data from an online survey with qualitative data from focus groups.
• Participants included various end-of-life care stakeholders in Canada.
• The survey incorporated the DLI and a clinical utility measure, alongside open-ended questions.

Main Results:

• Participants rated the DLI favorably for acceptability (4.3/5), relevance (3.9/5), and usefulness (4.1/5).
• Qualitative feedback indicated a need for simpler language and more comprehensive cultural and spiritual content within the DLI.
• The DLI's utility was recognized for initiating end-of-life discussions and program evaluation, though enhanced specificity was suggested for nuanced understanding.

Conclusions:

• The Death Literacy Index (DLI) demonstrates considerable potential for use in the Canadian context for end-of-life education evaluation.
• Further refinement and validation of the DLI are recommended to improve its cultural sensitivity, linguistic clarity, and specificity in assessing death literacy.