{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T18:29:39Z","timestamp":1779128979747,"version":"3.51.4"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The quality of palliative care depends on medical practitioners\u2019 death cognition and care ability, however, medical students worldwide generally face problems such as death anxiety and insufficient palliative communication skills. Existing studies have not yet formed systematic conclusions on the consistency of the effects of death education interventions and the optimal intervention model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA, 5 databases (PubMed, Web of Science, Cochrane Library, CNKI, Wanfang Data) were searched (2010.1\u20132025.10), including 12 non-randomized intervention studies (1,111 students). Quality was assessed using the Methodological Index for Non-Randomized Studies Scale (MINORS). Stata 18.0 conducted meta-analysis, with subgroup (intervention method, duration, culture), sensitivity, and publication bias (funnel plot, Egger\u2019s test) analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Meta-analysis showed that death education interventions (based on non-randomized intervention studies evidence) had potential positive effects: it reduced fear of death (SMD\u202f=\u202f\u22120.38, 95%CI [\u22120.59, \u22120.17]), death avoidance (SMD\u202f=\u202f\u22120.40, 95%CI [\u22120.64, \u22120.17]), and escape acceptance (SMD\u202f=\u202f\u22120.32, 95%CI [\u22120.58, \u22120.06]); meanwhile, it enhanced neutral acceptance (SMD\u202f=\u202f0.43, 95%CI [0.15, 0.72]) and approach acceptance (SMD\u202f=\u202f0.29, 95%CI [0.01, 0.58]). Additionally, preliminary results showed that death education interventions improved attitudes toward palliative care. Exploratory subgroup analysis revealed that: blended learning had the promising effect; interventions with a duration of \u226516 class hours showed better improvement; Chinese students exhibited significant improvement in neutral acceptance, while others performed better in approach acceptance. It should be noted that several subgroup analyses include small numbers of studies and are explicitly labeled as exploratory. Sensitivity analysis indicated that the pooled effect size had a small fluctuation range. The funnel plot and Egger\u2019s test suggested no significant publication bias. Pooled analyses of all DAP-R dimensions show very high heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      &amp;gt;\u202f80%), which may affect the reliability and generalizability of the pooled effect sizes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Caution is warranted in causal interpretation given the non-randomized nature of included studies. Death education interventions shows potential improving medical students\u2019 death attitudes and enhancing their palliative care literacy. Blended learning and \u226516 class hours might be more effective. It is suggested that medical colleges integrate it into core curricula, optimize design per culture, and build long-term follow-up systems to achieve \u201chumanity-technology integration.\u201d<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1754182","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T05:33:58Z","timestamp":1770183238000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of death education interventions on death attitudes in medical students: systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Nan","family":"Wang","sequence":"first","affiliation":[{"name":"School of Humanities and Social Sciences, Shanxi Medical University","place":["Taiyuan, Shanxi, China"]},{"name":"First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhizhong","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Humanities and Social Sciences, Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"105448","DOI":"10.1016\/j.nedt.2022.105448","article-title":"Using a mediating model of death attitude and meaning in life to understand nursing students attitude about hospice care","volume":"116","author":"Yu","year":"2022","journal-title":"Nurse Educ Today"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"105570","DOI":"10.1016\/j.nedt.2022.105570","article-title":"A meta-analysis of nursing students' knowledge and attitudes about end-of-life care","volume":"119","author":"Wang","year":"2022","journal-title":"Nurse Educ Today"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"212","DOI":"10.12968\/ijpn.2023.0072","article-title":"Efficiency of a palliative education programme for nursing students","volume":"31","author":"Ibrahim","year":"2025","journal-title":"Int J Palliat Nurs"},{"key":"ref4","first-page":"43","article-title":"Application effect of student-centered death education in improving nursing students' death attitudes","volume":"30","author":"Sun","year":"2023","journal-title":"Mod Nurse"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"7780","DOI":"10.1002\/nop2.2025","article-title":"Death education for undergraduate nursing students in the China Midwest region: an exploratory analysis","volume":"10","author":"Su","year":"2023","journal-title":"Nurs Open"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2271","DOI":"10.2147\/JMDH.S501701","article-title":"A scoping review of palliative care education for preregistration student nurses in the Asia Pacific region","volume":"18","author":"Agustina","year":"2025","journal-title":"J Multidiscip Healthc"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"105809","DOI":"10.1016\/j.nedt.2023.105809","article-title":"The effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: a mixed study design","volume":"126","author":"Wu","year":"2023","journal-title":"Nurse Educ Today"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"105013","DOI":"10.1016\/j.ijnurstu.2025.105013","article-title":"Journey of touching death, nursing undergraduates' experiences in the simulated death graded exposure programme: a qualitative descriptive study in China","volume":"164","author":"Peng","year":"2025","journal-title":"Int J Nurs Stud"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e3524PT","DOI":"10.1590\/1983-803420233524EN","article-title":"Training to cope with death from the perspective of future physicians","volume":"31","author":"Amoedo","year":"2024","journal-title":"Rev Bio\u00e9t"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e2214","DOI":"10.1002\/nop2.2214","article-title":"The impact of clinical internship experience on nursing students' attitudes towards death and choices of end-of-life care: a self-control study","volume":"11","author":"Jiang","year":"2024","journal-title":"Nurs Open"},{"key":"ref11","volume-title":"Nurses\u2019 attitudes toward death: examining the relationship with background and palliative education and training variables [Doctoral dissertation]. 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