The current study found that the majority of oncology nurses and physicians tend to have a positive attitude toward caring for dying patients. Furthermore, the majority of participants in this study contact dying patients on a daily basis, and cared for dying patients previously. Discussions regarding mortality actually appear to positively affect physicians' and nurses' attitudes toward death (Zyga et al., 2015). Furthermore, there is a statistically significant distinction in attitude toward caring for dying patients between both groups, the finding revealed that the physicians tend to have a more positive attitude toward death and caring for dying patients than Nurses (P< 0.05). The current study's findings interfere with the findings of a previous research study conducted in Greek (Zyga et al., 2015), which found a more positive attitude toward death among nurses compared to physicians. Consistently, the present research results are congruent with the finding of Shi et al., (2019), who revealed that the physicians had more positive attitudes toward dying care than nurses. on the other hand, the finding in the present study also contradicts the result of a previous research study conducted by Matsui, and Braun (2010), which showed no statistically significant difference in attitude toward death between nurses and health care workers.
Factors associated with participants’ attitude toward death and end-of-life care.
The present study revealed that there are a statistically significant differences in nurses’ and physicians’ attitude toward death between mean group based on their demographic characteristics. In the current study multiple demographic characteristics were examined includes age, gender, years of experience, receiving previous education on death and dying, religious beliefs, provided care for terminally ill patients previously, experience with loss, and present or previous experience with loss.
Age and gender with attitude toward death
The result showed that there is a statistically significant differences on the attitude toward death between mean groups among oncology nurses and physcians based on their age. As a result, the current study showed that the oldest nurses and physicians exhibited more positive attitudes towards caring for dying patients than the youngest nurses and physicians. Furthermore, this result is consistent with the finding of several previous research studies that support the assumption that age strongly influences the attitudes toward caring for dying patients and death (Park et al., 2017; Abu Hasheesh et al., 2014; Matsui and Braun, 2010; Shi et al., 2019; Cevik and Kav, 2013; Hagelin et al., 2016; Jafari et al., 2015; and Ozcelik et al., 2018). On the other hand, the current finding contradicts a previous study conducted by Faronbi et al., (2021) who found that older health care professionals had a less positive attitude toward death than younger participants.
Gender has indeed been recognized as a variable that impacts the attitudes toward death, as well as toward caring for dying patients. The current study found that male nurses and physicians had a more positive attitude than female participants. In contrast, our finding contradicts the finding of a previous Jordanian study (Abu hasheesh et al., 2014) which found no significant differences in attitude between males and females. Furthermore, the results are incongruent with the findings of numerous published studies (Abu-El-Noor and Abu-El-Noor, 2015; and Gama et al., 2012). Correspondingly, in concord with the finding, our result supports the finding of numerous previous research studies, for instance, a research study of nurses and other health care professionals discovered that female participants had a lower attitude toward caring for dying patients than male participants (Matsui and Braun, 2010).
Clinical experience and frequent exposure to death
According to the present findings, there is a statistically significant differences on the attitude toward death between mean groups among oncology nurses and physicians based on the length of experience. This finding could be explained by the assumption that experienced health care workers have been subjected to more dying patients in their daily work, which helps them develop a better understanding of terminally ill people across time (Park et al., 2017). The current result is in line with Cevik and Kav study (2013), which revealed that oncology nurses with more years of experience reported more positive attitudes toward caring for dying patients. Furthermore, the present finding is congruent with the finding of previous research studies (Gama et al., 2012; Malliarou et al., 2011; Shi et al., 2019; Lang et al., 2013; and Park, 2017), which conclude that the years of experience with terminally ill patients are one of the most influential predictors for a positive attitude toward caring for dying patients.
Religious beliefs
The current study revealed that more than half of study participant (60.5%) asserted that religious beliefs have a strong impact on their attitudes toward death and dying, while merely 11.5% of participants claimed that religious beliefs have no influence on their attitudes toward death and dying. As a result, religious beliefs were found to have a significant impact on physicians' and nurses' attitudes towards caring for dying patients and death. Furthermore, this conclusion is in accordance with the findings of numerous previous studies, which found that religious beliefs influence and assume a significant role in the development of positive attitudes toward death, and that those religious beliefs are considered as a predictive variable of positive attitudes toward death and dying care (Tranter et al., 2016; Barun et al., 2010; Wang et al., 2018; Cevik and Kav, 2013; and Neimeyer et al., 2004). On the other hand, these results contradict the findings of a previous study conducted among health care providers in China (Shi et al., 2019), which showed that religious beliefs had no statistically significant influence on attitudes toward end-of-life care.
Educational program
Regarding the previous educational courses related to death or dying care, only 34% of the participants confirmed attending a course about death or dying previously, while 19% of the participants claimed that they never attended or received any education about dealing with death and dying. These results are higher than what was reported in a Chinese study, where only 9% of the participants claimed that there is no information about dealing with death and dying was presented to them previously (Wang et al., 2018). On the other hand, 85% of nurse participants in a Turkish study claimed that they had participated in death educational courses previously (Cevik and Kav. 2013). Thus, the finding of the present study revealed that there is a lack of educational courses or training related to death or dying in Jordan, which is consistent with the finding of Al Qadire (2020) and support the recommendations of two previous studies to develop an orientation course related to death, dying, and palliative care for new employees, as well as delivering frequent workplace training courses (Abu Hasheesh et al., 2014and Al Qadire, 2014).
The present findings agree with numerous studies conducted among nursing students, nurses, medical students, or physicians to determine the variability in attitude towards death pre and post-death or end-of-life care courses (Jafari et al., 2015). Additionally, the same conclusion was found in the Swedish study after five weeks of the palliative educational course (Berndtsson et al., 2019). Correspondingly, the finding of these research studies (Hegedus, Zana and Szabó. 2008; Wilson et al., 2016; and Frommelt, 2003) showed that educational courses have a significant impact on the positive attitude toward end-of-life care. On the other hand, a few previously published studies were incongruent with this finding, and concluded that the educational courses did not make a significant influence on the attitude toward caring for dying patients (Wessel and Rutledge, 2005 and Shi et al., 2019).
personal experience with loss
Another interesting result was found in the present study, that the participants with previous personal loss experiences had a strong positive attitude towards death and caring for dying patients. Correspondingly, this result is inconsistent with the finding of a previous study conducted among nursing students, which revealed that students who had previous contact with terminally ill patients exhibited more optimistic attitudes than those who had not (Leombruni et al., 2014). Besides that, numerous studies were conducted among nurses and physicians previously revealed similar findings. For an instant, a study conducted among medical students (Leombruni et al., 2012). Correspondingly, this finding is supported by the result of a previous study conducted by Iranmanesh et al. (2008) which revealed that the loss experience of a close relative is considered as a positive influential factor on the attitude toward caring for terminally ill patients.
Educational level
The current study discovered that there is no statistically significant differences on the attitude toward death between mean groups among oncology nurses and physicians based on their academic educational level (Master's or Bachelor's). However, the present finding is in the same line with the finding of a previous study conducted (Barrere et al., 2008). In contrast, a previous study (Ali and Ayoub) concludes that the educational level positively impacts the nurses’ attitude toward caring for dying patients. However, the majority of participants have a bachelor’s degree; it is difficult to discuss what we found in terms of the present result.
Limitations and recommendations of this Study
The current study highlighted the main factors that affect the oncology nurses’ and physicians’ attitude towards death and end-of-life caring among. Additionally, this study filled the knowledge gap in associated factors that impacts on attitude toward death, as well as the study findings increased oncology nurses' and physicians' awareness about their attitude toward caring for dying patients. Importantly, the current study findings could be implied in both nursing and medicine fields to establish practice guidelines that improve attitudes regarding death and caring for dying patients, hence, improving the quality of care. Moreover, the current study showed the crucial roles of death education in enhancing the positive attitude toward death and dying. However, This study has a few limitations; first, the participants were recruited from only one specialized cancer hospital in Jordan. Second, the findings may be limited by the convenience sample of nurses and physicians, which is not representative of all Jordanian nurses and physicians and included only oncology nurses and physicians, which could potentially limit the generalization of the findings
Based on the finding of the present study and a previously published study, that the educational courses and continuous teaching regarding mortality, palliative care, end-of-life care significantly improve the positive attitude toward end-of-life care. Consequently, care of the dying patients, dying process, as well as mortality topics should be incorporated in the curriculum of the medicine and nursing students to enhance their attitudes towards death and end-of-life care. Furthermore, these topics should be covered during the clinical practice to adequately prepare them to provide comprehensive care for terminally ill patients and their families. Indeed, the findings of the present study offered valuable and useful relevant data regarding the influencing variables that significantly impact the attitude toward caring for dying patients. However, still there is a gap in evidence regarding improving and enhancing the positive attitude toward caring for dying patients among physicians and nurses. Therefore, the result of this study could be utilized as a reference point for future research studies and considered as a baseline for future studies investigating death the attitude toward death and caring for dying patients, also, the variables that influence and predict the attitude towards death and caring for dying patients among nurses and physicians in various clinical setting.