Impact of death education programs on nurses' and nursing students' mortality perceptions and end-of-life coping...

To evaluate the effects of death education on nurses' and nursing students' attitudes toward death and end-of-life care competence.

Systematic review and meta-analysis of RCTs and CCTs.

Seven databases (2014-2025) including PubMed, Embase, CNKI, etc.

Two reviewers independently screened, extracted data, assessed risk of bias (RoB 2.0), and rated evidence certainty (GRADE). Random-effects meta-analyses, subgroup, and sensitivity analyses were performed.

Thirteen studies (N = 1,142) were included. Death education significantly improved end-of-life care competence (SMD = 1.05, 95% CI: 0.76-1.34, p < 0.001, I² = 54%, moderate certainty). However, no significant effect was found on attitudes toward death (SMD = 0.25, 95% CI: -0.17 to 0.66, p = 0.24, I² = 83%, very low certainty). Subgroup analyses showed consistent benefits for online and in-person training. Sensitivity analyses confirmed robustness. Most studies had high risk of bias, and only 3/13 included follow-up.

Death education may enhance end-of-life care skills, but its impact on death attitudes is uncertain. Evidence is limited by high risk of bias, heterogeneity, and lack of long-term follow-up. Future rigorous RCTs with longer follow-up are required. Findings should be considered hypothesis-generating.