Factors influencing death anxiety among patients with end-stage chronic diseases: a scoping review.

AIMS: To systematically identify and map the influencing factors, assessment tools, and interventions for death anxiety among patients with end-stage chronic diseases.

DESIGN

A scoping review conducted in accordance with the JBI Global methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. DATA SOURCES: A systematic search was conducted across nine databases: CNKI, Wanfang, VIP, CBM, PubMed, CINAHL, Embase, Web of Science, and the Cochrane Library. The search covered the period from database inception to December 15, 2025. REVIEW

METHODS

Guided by the Population, Concept, and Context (PCC) framework, two researchers independently performed literature screening, data extraction, and quality appraisal using JBI Global Critical Appraisal Tools.

RESULTS

Sixty-eight original studies were included. The prevalence of high death anxiety among terminal patients ranged from 25 to 80% (mean = 53.30%). Influencing factors were identified across demographic, socioeconomic, disease-related, and psycho-behavioral dimensions. Commonly used assessment tools included the Templer Death Anxiety Scale (T-DAS), the Death and Dying Distress Scale (DADDS), and the Death Anxiety Questionnaire (DAQ). Current interventions primarily involve Acceptance and Commitment Therapy (ACT), Virtual Reality (VR)-integrated support, Life Review Therapy, Managing Cancer and Living Meaningfully (CALM) therapy, and Cognitive Behavioral Therapy (CBT).

CONCLUSION

Death anxiety is highly prevalent among patients with end-stage chronic diseases and is negatively correlated with quality of life. There is a critical need to implement culturally adapted measurement tools and disease-specific assessments. IMPACT: This review highlights the necessity of shifting the care paradigm from "cure-centered" to "dignity-centered". Nursing professionals should prioritize a systematic "early screening–precise assessment–dyadic intervention" approach, focusing on "patient-caregiver" dyadic models to alleviate the fear of death and promote end-of-life quality. NO PATIENT OR PUBLIC CONTRIBUTION: As this study is a scoping review based on the synthesis of publicly available literature, no patients, service users, caregivers, or members of the public were involved in the design, conduct, analysis, interpretation, or preparation of this manuscript.