Learning how to talk about approaching death: results from a pre-test post-test trial on the effectiveness of a blended-learning approach

Authors

Felix Michael Schmitz, Ann-Lea Buzzi, Sibylle Jeanine Felber, Sofia Carolina Zambrano, Tanja Hitzblech, Kai Philipp Schnabel, Steffen Eychmüller, Sissel Guttormsen (2025)

Abstract

Background:
Caring for dying individuals is a key aspect of many clinical and medical practices. However, training and reflection opportunities on conversations between healthcare professionals, dying patients, and caregivers are limited. To address this gap, we developed a blended-learning approach focusing on effective communication about approaching death, termed Talking About Dying (TAD). This study aimed to evaluate the impact of this approach on pre- and postgraduate medical learners' knowledge, anxiety, self-efficacy, and skills related to TAD.

Methods:
A pre-test post-test trial with n = 12 medical students and n = 11 nursing professionals was applied. Data were collected at three time points: (1) at baseline (pre-intervention) (2), after a 45-minute online TAD module (post-intervention I), and (3) after a 90-minute onsite workshop with experts (post-intervention II). Knowledge was tested with self-developed multiple-choice questions, while anxiety when discussing death and self-efficacy were assessed using published questionnaires, i.e., the 7-item Thanatophobia Scale and a 1-item scale according to Bandura. Participants demonstrated their TAD-related skills in encounters with simulated patients, which were scored by trained assessors using a self-developed scale. The TAD online module (intervention I) included text and video demonstrations with critical hints, while the onsite workshop (intervention II) involved group reflection, discussion, and role-play to deepen understanding.

Results:
Participants demonstrated increased knowledge, reduced thanatophobia (amongst medical students but not nursing professionals), and enhanced self-efficacy and skills following both interventions, with these effects being both statistically and practically significant.

Conslusions:
Combining an online module with an in-person workshop can meaningfully enhance learning outcomes across cognitive, affective, and behavioural dimensions related to TAD conversations for both medical students and professional nurses, though changes in the affective dimensions were observed only in students. We recommend integrating this method into medical and nursing education.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study does not fall under Article 2, Paragraph 1 (Scope) of the Swiss Federal Act on Research Involving Human Beings (Human Research Act, HRA). Thus, the independent cantonal Bernese ethics committee declared that authorization was unnecessary and deemed the study exempt from full ethical review (REQ-2019-00977). We complied with international Good Practice Guidelines (GPG) for research involving human beings. The participants provided written informed consent for the material to be used for research purposes. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.