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

Programs providing end-of-life education require a standardized tool to identify knowledge gaps and evaluate programming. The aims of this mixed methods study was to examine the perceived clinical utility of the Death Literacy Index (DLI) in the Canadian context. An online survey and focus groups captured quantitative and qualitative data from end-of-life care stakeholders. The survey included the DLI and a measure of clinical utility. Participants rated the DLI positively on a 5-point Likert scale: acceptability (4.3), relevance (3.9), and usefulness (4.1). Qualitative findings supported these ratings and highlighted areas for improvement, including simpler language and more inclusive cultural and spiritual content. Ratings for usefulness reflected the index's potential for initiating end-of-life discussions and program evaluation, though participants noted it may need more specificity to capture nuanced understandings of death literacy. Overall, the findings suggest the DLI requires further refinement and validation to enhance its applicability in the Canadian context.