Type of contribution:Scoping Review Death Readiness among Terminally Ill Patients: A Scoping Review

Type of contribution:Scoping Review Death Readiness among Terminally Ill Patients: A Scoping Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Type of contribution:Scoping Review Death Readiness among Terminally Ill Patients: A Scoping Review xinyu ju, zhaomeng zhang, yujin zhang, Jinhua Hong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8211775/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Objective: To conduct a comprehensive review of relevant studies on the readiness for death of terminally ill patients at home and abroad, and systematically analyze their influencing factors, assessment tools, and intervention strategies. Design: Scoping review. Data sources: Systematic searches were performed in two Chinese databases (CNKI, Chinese Biomedical Literature Database) and six English databases (PubMed, Cochrane Library, MEDLINE, Embase, Web of Science, CINAHL) from their inception until May 13, 2025. Method: Two reviewers independently retrieved full-text studies and conducted the initial screening of titles and abstracts, followed by full-text analysis and data extraction. In case of any disagreement, the final decision was reached with participation of a third investigator. Result: A total of 17 articles were included in this review. 5 reports on the influencing factors of death readiness were presented. The investigated influencing factors covered sociodemographic factors, individual factors, and environmental factors. It involves 5 death readiness assessment scales, primarily evaluating psychological aspects, quality of life, and attitude towards death. 1 paper on the development of the model of death preparation. 10 studies reported interventions for death preparedness, primarily including Meaning-centered positive psychological intervention, palliative care, reminiscence therapy, and death education. Conclusion: Based on the scope review method, this study sorted out the main influencing factors of death readiness of dying patients, and proposed that the existing intervention measures should be improved in combination with these factors, so as to improve the level of death readiness of dying patients. In the future, it is necessary to develop multi-dimensional assessment tools adapted to local culture to support the formulation of individualized intervention strategies, so as to improve the death readiness of dying patients as a whole and promote their good death. Impact: This review clarifies the key gaps in the study of death readiness of dying patients, and provides a theoretical basis and practical direction for the development of targeted assessment tools and personalized intervention strategies. Report format: Follow the PRISMA Extension (PrisMA-SCR) guidelines for scope definition review, and use a literature screening flowchart to present the search and inclusion process. Patient or public contribution: No. Figures Figure 1 Figure 2 1 Background In recent years, the global incidence of malignant tumors has continued to rise, making cancer one of the leading causes of mortality and morbidity worldwide. According to data released by the World Health Organization's International Agency for Research on Cancer (IARC), approximately 19.29 million new cancer cases were diagnosed globally in 2020, with close to 9.96 million deaths attributed to the disease[ 1 ].As a country with a high cancer incidence, China accounts for a relatively high proportion of both new cancer cases and cancer-related deaths globally, posing severe challenges to cancer prevention and control. Notably, most patients are already at the moderate to advanced stage at the time of diagnosis. When the disease progresses to the terminal stage, they often confront multifaceted suffering, including physical, psychological, and social dimensions[ 2 – 4 ].As the final phase of disease progression, the terminal stage in end-of-life care presents an urgent question that demands exploration: how to ensure a peaceful passing for terminally ill patients[ 5 ].Additionally, with societal progress and improving living standards, people are gradually paying more attention to and pursuing the quality of life and the quality of death, making it imperative to enhance death preparedness for patients with advanced cancer[ 6 , 7 ].Research indicates that a good death requires both patients and caregivers to have a high level of preparedness for death.Therefore, enhancing death readiness among patients with advanced cancer is imperative[ 8 ]. Death preparation refers to an individual's psychological, cognitive, behavioral, and social readiness for death during the terminal phase of life. Research indicates that effective death preparation holds significant importance for patients, families, and society at large. For patients, thorough death preparation helps alleviate death anxiety and stress, fosters a more positive perception of death, reduces unnecessary medical interventions, and enhances quality of life during the final stages of life[ 9 , 10 ].For family caregivers, preparing for death can alleviate the burden of decision-making and the pain of bereavement, while preventing family conflicts arising from poor communication[ 11 – 13 ].From the perspective of the healthcare system, enhancing end-of-life preparation helps optimize resource allocation and improve the efficiency and quality of compassionate care in terminal stages[ 14 ].Therefore, death preparation is not only a psychological adaptation process at the individual patient level but also an integral part of the overall palliative care system. Currently, research on end-of-life preparedness among terminally ill patients has yielded relevant reviews and systematic evaluations of intervention measures[ 15 , 16 ]. However, there are still some problems, such as unclear definition of concepts, unsystematic clarification of influencing factors, relatively limited evaluation tools, diverse intervention measures and scattered evidence, and a systematic and integrated knowledge framework has not yet been formed[ 17 ]. In order to sort out the research status in this field, integrate the existing evidence and clarify the future research direction, it is of great theoretical value and practical reference significance to carry out a review of the concept connotation, influencing factors, evaluation tools and intervention strategies of death readiness of dying patients. Scope review methods are suitable for systematically organizing knowledge in complex and under-explored research domains[ 18 ].This study conducted a systematic review to synthesize and analyze existing literature on the concept of death readiness in terminally ill patients, its influencing factors, relevant assessment tools, and associated intervention measures. 2 Methods This study utilised Arksey and O'Malley's framework[ 19 ]to conduct a scoping review in order to systematically search, select and synthesise existing knowledge. The framework consists of several key stages: identifying the research question, identifying relevant studies, selecting studies, charting the data, and collating, summarising, and reporting the results. The PRISMA extension (PRISMA-ScR) [ 20 ]for scoping reviews was followed in this study.Ethical approval was not required for this review of the existing literature. 2.1 Stage 1: Identifying the Research Question The research questions identified to address the objectives of this scoping review are as follows: ①What are the primary factors influencing end-of-life preparedness among terminally ill patients? ②What are the assessment tools for end-of-life preparedness and how are they utilized? ③What interventions exist to address end-of-life preparedness among terminally ill patients? 2.2 Stage 2: Identifying Relevant Studies Computerized searches were conducted in PubMed, The Cochrane Library, MEDLINE, Embase, CINAHL, Web of Science, the Chinese Biomedical Literature Database, and China National Knowledge Infrastructure (CNKI). The search time span was set from the inception of each database to May 13, 2025. The search strategy combined subject headings with free-text terms. Example PubMed search strategy: “Death Preparation”[Title/Abstract] OR “Death Preparedness”[Title/Abstract] OR “Death planning”[Title/Abstract] OR “end of life preparedness”[Title/Abstract] OR “end of life preparation”[Title/Abstract] OR “Death readiness”[Title/Abstract] 2.3 Stage 3: Literature Inclusion and Exclusion Criteria Inclusion Criteria: ①Study subjects were terminally ill patients or their primary caregivers, aged ≥ 18 years; ②Study topics involved factors influencing death preparedness, assessment tools, or interventions; ③Literature type was original research. Exclusion Criteria: ①Literature not reported in Chinese or English; ②Literature with unavailable full text, duplicate publications, incomplete data, or low quality; ③Reviews, case reports, experimental protocols, opinion pieces, etc. Deduplication performed using NoteExpress software. Titles and abstracts of all studies were initially screened against inclusion and exclusion criteria. Full texts of preliminarily selected studies underwent comprehensive eligibility assessment. Two independent reviewers conducted this screening. Disagreements were resolved through discussion or consultation with a third reviewer. The selection process is illustrated in the flowchart (Fig. 1 ). 2.4 Stage 4: Data Extraction and Charting A customized data extraction table was developed to systematically collect and organize key information from the selected literature. This included authors, publication dates, countries, study types, sample sizes, intervention durations, assessment metrics, influencing factors, and research themes. To facilitate comparative analysis with English-language studies, data extracted from Chinese research were translated into English. Two reviewers independently extracted data from each included article, with any discrepancies resolved through discussion with a third researcher. No formal assessment of methodological quality or reliability was conducted, as this fell outside the scope of this review. 3 Results 3.1 Study Characteristics of Included Literature The included literature was published from 2009 to 2025, and the research sites were distributed in the United States ( n = 5 ), China ( n = 3 ), China 's Taiwan ( n = 1 ), Canada ( n = 1 ), Kenya ( n = 1 ), India ( n = 1 ), Japan ( n = 1 ), Spain ( n = 2 ), Australia ( n = 1 ), and Thailand ( n = 1 ). Research type : 1 cross-sectional study, 1 longitudinal study, 3 mixed studies, 1 cohort study, 1 qualitative study, 10 intervention studies. Table 1 summarizes the characteristics of the included studies.The basic characteristics of the included literature are shown in Table 1 and the definition, influencing factors, assessment tools and interventions of death preparation are shown in Fig. 2 . Table 1 General information of the included studies(n = 17) # Author Country Type of study Research object Sample Size Intervention methods Intervention frequency / duration Evaluation tools Influencing factors Theme [ 21 ] Asatsa et al. (2020) Kenya combining cross-sectional and phenomenological designs non-clinical residents 335 —— —— the Death Attitude Profile-Revised(DAP-R) Age death attitudes To explore the predictive effect of death attitudes on death preparedness among non-clinical populations [ 23 ] Cicirelli et al. (2011) U.S. Mixed-methods elders 132 —— —— the Death Attitude Profile-Revised(DAP-R); the Life Attitude Profile-Revised(LAP-R) religious To explore the effects of religious and nonreligious spirituality on attitudes toward 'death acceptance' and 'death rejection' among elders [ 25 ] Mah et al. (2020) Canada Longitudinal study Patients with advanced cancer and partners 289 —— —— Death Preparation Scale (DPS) the validated Quality of Life at the End of Life (QUAL-E) couple communication Gender age To explore how attachment security influences death preparation in patients with advanced cancer, and whether couple communication mediates this relationship [ 22 ] Wen et al. (2023) Taiwan Region of China Cohort study Advanced cancer patients 314 —— —— the validated Quality of Life at the End of Life (QUAL-E) Gender Age Years financial hardship disease burden Physician prognostic disclosure patient-family communication social support To explore the factors associated with death preparedness states in cancer patients [ 24 ] Miranda-Díaz et al. (2022) Spain Cross-sectional study elderly population 91 —— —— Death Anxiety Scale (DAS) Cultural religious emotional aspects to compare the levels of death anxiety, fear of death, attitudes towards death and associated emotional aspects (anxiety and depression) in older adults from 2different cultures, Western and Arab [ 26 ] Zhang et al. (20250 China Exploratory mixed-methods advanced cancer patients 753 To develop measurement tool for death preparedness —— Preparation for Final Passing-Revised (PFP-R) —— [ 5 ] Zhang et al. (2025) China Qualitative Research 12 advanced cancer patients, 11 family members, 16 nurses and 4 doctors 12 —— —— —— Cognitive Dimension Affective Dimension、Behavioral Dimension、Social Dimension To develop a model of death preparedness in patientswith advanced cancer [ 27 ] Gil et al. (2018) Spain RCT cancer inpatients in the end of life 51 Meaning-centered psychotherapy integrated with elements of compassion 3 sessions, approximately 45–60 minutes per session The Feasibility, acceptability, and utility for the pre- and posttreatment questionnaires —— meaning, self-compassion, compassion, legacy, and courage and commitment. [ 28 ] Steinhauser et al. (2009) U.S. RCT Hospice-eligible subjects 82 Outlook intervention 3 sessions, approximately 45–60 minutes per session the Quality of Life at the End of Life(QUAL-E) —— The impact of 'Preparation and Life Completion' on patients' function, emotions, and death preparedness in at the end of life [ 29 ] Steinhauser et al. (2017) U.S. RCT seriously ill patients 221 Outlook intervention 3 sessions, approximately 45–60 minutes per session the Quality of Life at the End of Life(QUAL-E) —— To investigate the effect of Outlook Intervention on addressing patients' emotional and existential needs during serious illness [ 30 ] Steinhauser et al. (2008) U.S. RCT seriously ill patients 82 Outlook intervention 3 sessions, approximately 45–60 minutes per session the Quality of Life at the End of Life(QUAL-E) —— To examine whether discussions on ' promotes discussions of end-of-life preparation and completion ' improve function and quality of life in patients with serious illness [ 31 ] Keall et al. (2013) Australia RCT palliative care patients with advanced cancer or other life-threatening illnesses Not specified Outlook intervention 3 sessions, approximately 45–60 minutes per session the Quality of Life at the End of Life(QUAL-E) —— to explore the acceptability and feasibility of a nurse-facilitated preparation and life completion intervention (Outlook) in an Australian palliative care patient population. [ 32 ] Saeedi et al. (2019) Iran RCT patients with cancer 61 The positive psychotherapy eight 90-min sessions held weekly the Life Attitude Profile-Revised (LAP-R) —— to investigate the effect of positive psychotherapy on understanding the meaning of life in patients with cancer. [ 33 ] Trakoolngamden et al. (2025) Thailand Quasi-experimental Study advanced cancer and their family caregivers 122 a peaceful end-of-life care program 4 weeks, 45–60 min/session —— —— to examine the effect of a peaceful end-of-life care program on perceived good death outcomes in people with advanced cancer and their family caregivers [ 17 ] Song et al. (2024) U.S. RCT patients receiving dialysis and their families 426 SPIRIT ACP intervention 45 ~ 60min discussions in the clinic or remotely, A short-term follow-up can be conducted after 2 weeks —— —— To explore the effectiveness of advance care planning (ACP) strategies for patients receiving dialysis and their families [ 34 ] Ando et al. (2010) Japan Intervention Study patients with advanced cancer 68 Short-Term Life Review Twice a week, approximately 60 minutes per session, for 1 consecutive week —— —— To verify the enhancing effect of short-term life review on spiritual well-being, anxiety/depression, and 'good death' elements in patients with advanced cancer [ 35 ] Li et al. (2023) China A before-and-after study patients with advanced cancer 32 online-offline integrated death education in a 4-week the Life Attitude Profile-Revised (LAP-R); Templer's Death Anxiety Scale, (DAS) —— To evaluate the Effects of online-offline integrated death education on patients with advanced cancer 3.2 Factors Influencing End-of-Life Readiness in Terminally Ill Patients Among the five studies examining relevant influencing factors, it was found that most domestic and international research on factors affecting end-of-life preparedness among terminally ill patients primarily focused on three areas: demographic factors, environmental factors, and individual factors. Individual Factors These include attitudes toward death, disclosure of prognosis, and religious beliefs. One study[ 21 ]indicated that attitudes toward death are associated with preparedness for death. One study[ 22 ] demonstrated that disclosure of prognosis is related to preparedness for death. Two studies [ 23 , 24 ] revealed that religious beliefs correlate with preparedness for death. Environmental Factors Includes communication between patients and families, social support, and cultural differences. Two studies[ 22 , 25 ]indicate that communication between patients and family members correlates with levels of death preparedness, and that attachment security can support death preparedness in advanced cancer through improved spousal communication. One study [ 25 ] demonstrates that social support is associated with death preparedness. One study[ 24 ] shows that cultural differences influence family communication and levels of death preparedness. 3.3 Assessment Tools for Death Readiness in Terminally Ill Patients Currently, there are no universally recognized assessment tools or standards for evaluating death readiness in terminally ill patients. Included assessment tools comprise the Quality of Life at the End of Life (QUAL-E)[ 22 , 25 ], the Death Anxiety Scale (DAS)[ 24 ], the Death Attitude Profile-Revised (DAP-R)[ 21 , 23 ], the Life Attitude Profile-Revised (LAP-R)[ 23 ], and the Preparation for the Future Professional Scale-Revised (PFP-R)[ 26 ]. 3.4 Interventions, Evaluation Indicators, and Outcomes for Death Readiness in Terminally Ill Patients The interventions included in the 10 studies comprised Meaning-centered positive psychological intervention, palliative care treatment, reminiscence therapy, and death education. The effect of ' meaning-centered ' positive psychological intervention Six studies[ 27 – 32 ]primarily implemented psychotherapy, specifically an intervention combining meaning-centered psychotherapy with compassion elements. This intervention was administered to 30 cancer patients. Results showed no significant differences between treatments, but patients reported the most useful elements or structures as meaning, self-compassion, compassion, legacy, and courage and commitment[ 27 ]. Four studies designed the Outlook intervention, incorporating life stories, forgiveness, and legacy. Results consistently demonstrated that the Outlook intervention provides a brief, standardized, and portable approach to improving quality of life for patients with advanced serious illnesses [ 28 – 31 ]. However, one study noted that compared to standard care interventions, Outlook influenced social well-being and preparedness but had no effect on anxiety or depression and showed no significant benefit for individuals not experiencing existential or emotional distress[ 29 ]. One study employed positive psychotherapy through eight 90-minute weekly group sessions with 61 cancer patients. Results indicated that positive psychotherapy effectively enhanced patients' levels of meaningful living, enjoyment, and life commitment[ 32 ]. Effectiveness of Palliative Care Interventions Two studies [ 17 , 33 ] primarily implemented palliative care interventions. One study designed a 4-week program based on standard care, incorporating health education, symptom management self-care, advance care planning, psychosocial support, and family involvement. Results demonstrated significant improvements in the intervention group regarding perceived good death, quality relationships, and palliative care knowledge[ 33 ]. Another study employed a pre-care planning intervention guided by the structured SPIRIT framework, demonstrating that implementing pre-care planning improved preparedness for end-of-life decision-making[ 17 ]. Effects of Other Intervention Methods The remaining two studies[ 34 , 35 ] employed retrospective therapy and death education. One study employed short-term life review therapy, demonstrating that brief life review effectively improved mental health, reduced psychosocial distress, and promoted a good death among patients with advanced cancer[ 34 ]. Another study designed a 4-week blended online-offline death education program, which enhanced participants' capacity to confront death while also helping family members prepare psychologically and physically for the loss of a loved one[ 35 ]. 4 Discussion 4.1 There are many factors affecting the death preparation Demographic Factors Demographic factors include age, gender, economic status, and disease burden. Multiple studies[ 21 , 22 , 25 ] indicate that older terminally ill patients exhibit relatively higher death readiness. Wen et al. [ 22 ] showed that age growth was positively correlated with emotional acceptance and preparation for death, but negatively correlated with the level of accurate prognostic awareness. The reason for the analysis is that the death of the elderly is regarded as the law of nature, while the early death is contrary to filial piety and life expectations, so the emotional preparation of the elderly for death is relatively sufficient. At the same time, under the concept of Confucian filial piety, children return and protect their elderly parents, resulting in ' protective concealment ', but may reduce the patient 's right to know and independent decision-making ability, resulting in insufficient cognitive preparation, consistent with Zhang et al. [ 5 ]qualitative research results. Therefore, medical staff should actively communicate with the patient 's family members, indicating that moderate informing the prognosis is helpful for the patient to arrange follow-up matters, and it is recommended that the communication process can be used in a gradual manner, according to the patient 's emotional state to disclose information in batches, and maintain sufficient emotional support throughout the process. Studies have shown that men are more likely to be emotionally prepared and fully prepared than women, and that men generally have better quality of communication between husband and wife than women[ 22 , 25 ]. This may be related to the role expectations and coping styles given by society. For example, in traditional culture, men assume the role of family decision-making and are encouraged to suppress emotions to maintain family harmony, while women are more likely to be affected by attachment anxiety because they pay more attention to communication. Therefore, nursing staff can provide personalized psychological intervention, strengthen their decision-making role for men, help them accept death and plan for future events, and provide emotional support for women, encouraging the expression of concerns and fears. Wen et al. [ 22 ] showed that cancer patients with economic difficulties and painful symptoms were negatively correlated with the emotional state and full preparation for death. The reason for this analysis is that as pain and other physical symptoms accelerate, patients may be too afraid to participate in fears about their own and their families ' futures, thus impeding death preparation[ 36 ]. At the same time, financial stress can increase patients ' psychological distress and may also limit their access to adequate medical resources and social support, which in turn affects their emotional and full readiness for death. Therefore, it is recommended that standardized symptom assessment be used as an opportunity to start an advance care plan. On the basis of effectively alleviating pain and building trust, patients should be guided to express their willingness and values for future medical care when symptoms are controllable, and their economic pressure should be evaluated simultaneously. Provide practical resource assistance, so as to systematically transform clinical care into nursing practice that improves patients ' cognitive and emotional readiness. Individual Factors Individual factors include attitudes toward death, prognosis disclosure, religious beliefs, and others. Asatsa et al. [ 21 ]used a mixed method sequential design to select 335 participants of different age groups through multi-stage sampling. It was found that negative death attitudes decreased with age, and positive death attitudes increased with age, which in turn affected death readiness. The negative death attitude stems from death threats, unmet goals, etc., and the positive attitude is due to the reunion of relatives and friends. Therefore, medical staff can carry out life education lectures or group counseling for young people to help them alleviate the fear of death ; at the same time, the elderly are encouraged to strengthen the family connection by writing memoirs and family story meetings, so as to improve the psychological preparation of different age groups for the end of life. Wen et al. [ 22 ] have shown that doctors ' prognosis disclosure can increase the possibility of patients being in a cognitive state and fully prepared. The reason is that doctors ' prognosis disclosure allows patients to better understand their own conditions, so as to better prepare for death cognitively and emotionally. It is consistent with the results of the second study of Staats et al. [ 22 , 37 ]. Therefore, it is recommended to encourage medical staff to actively provide patients with clear prognostic information and give psychological support. Cicirelli [ 23 ]Studies have shown that the concept of the afterlife of religious beliefs helps to improve the death readiness of the elderly, and non-religious elderly people are more willing to accept life extension and rejection of death. The reason for the analysis is that non-religious beliefs emphasize more on personalized meaning construction, so that individuals seek opportunities to prolong life and refuse death. It is recommended that medical staff fully respect the patient 's religious background, evaluate the individual 's value system, and find adaptive psychological intervention methods for the reconstruction of life meaning, so as to effectively improve the patient 's death preparation level. Environmental Factors Family social environment factors, including communication between patients and their families, social support, cultural differences, etc. For families of dying patients, talking about death is difficult, and reduced family communication often leads to increased uncertainty, with adverse effects on patients and their families. The results of two [ 22 , 25 ]studies showed that communication between dying patients and their families on end-of-life issues was helpful to improve the readiness for death of both parties. The analysis of the reasons for the discussion of end-of-life and death-related issues between patients and their spouses could narrow the gap between the two sides on end-of-life issues, promote the sharing of their own feelings, and thus reduce the degree of pain. Therefore, it is recommended that nursing staff carry out structured family communication interventions, such as guiding families to participate in family dignity therapy or couple communication skills to guide death topics, and promote frank communication about dying intentions in a safe atmosphere. Wen et al. [ 22 ]have shown that high social support increases emotional preparation, but cognitive preparation may be weakened, and family members may selectively conceal prognostic information to protect patients, thus weakening their cognitive preparation. Therefore, on the basis of respecting the willingness of family emotional protection, nursing staff should guide family members to realize the importance of moderate information sharing to patients ' independent decision-making, and suggest that family members can adopt progressive information disclosure strategy to inform the patient 's condition in stages according to the patient 's psychological tolerance, so as to help the family seek a balance between emotional support and cognitive preparation. Miranda-Díaz et al. [ 24 ]found that in collectivist cultures, religious identity as a social norm may indirectly strengthen fear of death through the mediating role of depression, which emphasizes the cultural specificity of the emotional regulation path of death anxiety. The reason is that when patients regard religious norms as group norms that must be observed, they are prone to feel ashamed of being unable to meet the standards, and at the same time suppress their true feelings in order to maintain group harmony. This inner contradiction will aggravate emotional distress. 4.2 Limitations in the Uniformity and Applicability of Death Readiness Assessment Tools In previous studies on death readiness of dying patients, the assessment tool has a single lack of multi-dimensional assessment of death readiness. For example, the Quality of Life at the End of Life ( QUAL-E ) [ 22 , 25 ]provides a comprehensive assessment, and has good reliability and validity, but it focuses more on quality of life rather than death readiness, and patient self-reporting may be inaccurate. The Death Anxiety Scale ( DAS ) [ 24 ] can effectively assess the degree of death anxiety, but the direct correlation with death readiness is weak, and it is limited by a single dimension and cannot capture complex emotions. The Death Attitude Profile-Revised ( DAP-R ) [ 21 , 23 ] is a multi-dimensional psychological assessment, which can fully understand the patient 's attitude towards death, but some dimensions may have poor cultural adaptability, and the items may not be suitable for certain cultural backgrounds. The revised Life Attitude Profile-Revised ( LAP-R ) [ 23 ] can comprehensively assess the patient 's attitude towards life and death, and provide a certain reference for understanding the patient 's readiness for death. However, the scale mainly focuses on life attitude, and the direct correlation with the readiness for death is weak, so it cannot accurately measure the patient 's specific readiness for death. The Preparation for the Future Professional Scale-Revised ( PFP-R ) [ 26 ]is specifically developed for patients with advanced cancer, but has not been fully validated in other end-stage populations such as chronic organ failure and neurodegenerative diseases. In view of the limitations of the above assessment tools, it is suggested that future research should focus on the construction of localized multi-dimensional assessment tools in line with Chinese culture, and integrate multiple dimensions such as cognition, emotion, behavior and social culture to comprehensively assess the level of death preparedness of dying patients. 4.3 The simplification of death preparation intervention model is difficult to cope with multidimensional needs. Based on the results of included studies, we found that interventions can significantly improve patients' end-of-life preparedness. For instance, meaning-centered therapy[ 27 ], the Outlook intervention [ 28 – 31 ], and death education[ 35 ] enhance readiness by strengthening the sense of life meaning and social well-being. Over time, death readiness significantly increased among participants in death education programs[ 38 ].In summary, all studies have reported positive results in the dimension of death preparation, confirming the effectiveness of intervention. However, there is still a lack of standardized assessment tools for the outcome indicators of intervention measures in the assessment of death preparation, and the current intervention has limitations such as single focus and insufficient individual adaptation, which is difficult to fully meet the needs of patients[ 39 ]. In addition, the study found that the degree of death acceptance of patients showed significant individual differences and time-varying characteristics, which required that the intervention program must have sufficient flexibility and responsiveness[ 40 ]. In view of the dispersion and single-dimensional limitations of current death preparation interventions, future research should focus on building an integrated intervention system. The system should be based on standardized multi-dimensional assessment tools, accurately identify the specific needs of patients in multiple dimensions, and integrate artificial intelligence clinical decision support system. By analyzing the patient 's physiological indicators and psychological state data, it provides a basis for personalized matching of intervention strategies. According to the evaluation results and the changes of patients ' disease stage, cultural background and preparation degree, a dynamic adjustment mechanism is established to finally realize the transformation from standardized intervention to precise support, and comprehensively improve the quality of death preparation for patients with advanced cancer. 4.4 Limitations There are some limitations in this study. First of all, as a scope review, there is no methodological quality assessment of the included literature, and the strength of the evidence for the conclusion needs to be carefully considered. Secondly, although the retrieval strategy covers both Chinese and English databases, all the included literatures ( n = 17 ) are finally published in English, with potential language and publication bias, which may not fully integrate the relevant research in the Chinese context, especially the lack of reflection on the local practice and cultural perspective of mainland China. Therefore, the influencing factors, assessment tools and intervention strategies summarized in this paper are mainly based on the evidence under the international academic discourse system, and their ability to directly apply to the clinical and cultural environment of China is limited. Thirdly, the number of included studies is small, and the heterogeneity of cultural background is high, which limits the integration depth and external generalization of the results. These limitations suggest that this review mainly reviews the relevant research in the international English literature in this field, and has an important reference for the future development of localized and contextualized high-quality death preparation research for dying patients in China. 5 Summary This scope review systematically reviews the research status of death readiness of dying patients, and clarifies that death readiness includes four aspects : psychology, cognition, behavior and society. The research summarizes its main influencing factors, including demographic characteristics, individual psychological state and environmental support. The existing assessment tools are mostly focused on the psychological and attitude dimensions, and there is still a lack of integrated localized multi-dimensional tools. Interventions involve various forms such as positive psychotherapy, advance medical plans, and death education, but a systematic and individualized integration plan has not yet been formed. In the future, a multi-dimensional evaluation system suitable for Chinese culture should be constructed, and a comprehensive intervention model based on empirical and dynamic adaptation should be developed, so as to improve the level of death preparation of dying patients and promote them to achieve good death. Declarations Submitted for review and possible publication in ： BMC Palliative Care Ethics approval and consent to participate Not applicable Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding Not applicable. Author Contribution Hong Jinhua (H.J.) led the study conceptualization, methodology, and original draft preparation. Zhang Zhaomeng (Z.Z.) and Yu Xinyu (Y.X.) contributed to literature screening, data extraction, and analysis. Zhang Yujin (Z.Y.) supervised the project and provided critical revisions. All authors reviewed and approved the final manuscript. Acknowledgements Not applicable. Data Availability Not applicable. References Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. Cancer J Clin. 2021;71(3):209–49. 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Family Caregivers' Preparations for Death: A Qualitative Analysis. J Pain Symptom Manag. 2018;55(6):1473–9. Iskandar AC, Rochmawati E, Wiechula R. Experiences and perspectives of suffering in cancer: A qualitative systematic review. Eur J Oncol nursing: official J Eur Oncol Nurs Soc. 2021;54:102041. Hovland-Scafe CA, Kramer BJ. Preparedness for Death: How Caregivers of Elders With Dementia Define and Perceive its Value. Gerontologist. 2017;57(6):1093–102. Dying in America. improving quality and honoring individual preferences near the end of life. Mil Med. 2015;180(4):365–7. Jimenez G, Tan WS, Virk AK, Low CK, Car J, Ho AHY. Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons. J Pain Symptom Manag. 2018;56(3):436–e459425. Zhang X, Zhao M, Zeng T, Wei X. Death preparedness interventions for patients with advanced cancer: A systematic review. Asia-Pacific J Oncol Nurs. 2025;12:100697. Song MK, Manatunga A, Plantinga L, Metzger M, Kshirsagar AV, Lea J, Abdel-Rahman EM, Jhamb M, Wu E, Englert J, et al. Effectiveness of an Advance Care Planning Intervention in Adults Receiving Dialysis and Their Families: A Cluster Randomized Clinical Trial. JAMA Netw open. 2024;7(1):e2351511. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. Arksey H. O'malley LJIjosrm: Scoping studies: towards a methodological framework. 2005, 8(1):19–32. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MD, Horsley T. Weeks LJAoim: PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. 2018, 169(7):467–73. Asatsa S. Death Attitudes as Possible Predictors of Death Preparedness across Lifespan among Nonclinical Populations in Nairobi County, Kenya. Indian J Palliat Care. 2020;26(3):287–94. Wen FH, Hsieh CH, Chou WC, Su PJ, Hou MM, Shen WC, Chen JS, Chang WC, Tang ST. Factors associated with cancer patients' distinct death-preparedness states. Psycho-oncology. 2023;32(7):1048–56. Cicirelli VG. Religious and nonreligious spirituality in relation to death acceptance or rejection. Death Stud. 2011;35(2):124–46. Miranda-Díaz S, Hassan BH, Fernández-Alcántara M, García-Caro MP. [Attitudes and anxiety towards death in elderly people from 2different cultures: Spain and Egypt]. Revista espanola de geriatria y gerontologia 2022, 57(3):168–173. Mah K, Shapiro GK, Hales S, Rydall A, Malfitano C, An E, Nissim R, Li M, Zimmermann C, Rodin G. The impact of attachment security on death preparation in advanced cancer: The role of couple communication. Psycho-oncology. 2020;29(5):833–40. Zhang X, Wei X, Zhao M, Zeng T, Chen Y. Death Preparedness Scale for Advanced Cancer Patients: Instrument Development and Psychometric Properties. Psycho-oncology 2025, 34(4):e70149. Gil F, Fraguell C, Benito L, Casellas-Grau A, Limonero JT. Meaning-centered psychotherapy integrated with elements of compassion: A pilot study to assess feasibility and utility. Palliat Support Care. 2018;16(6):643–7. Steinhauser KE, Alexander SC, Byock IR, George LK, Tulsky JA. Seriously ill patients' discussions of preparation and life completion: an intervention to assist with transition at the end of life. Palliat Support Care. 2009;7(4):393–404. Steinhauser KE, Alexander S, Olsen MK, Stechuchak KM, Zervakis J, Ammarell N, Byock I, Tulsky JA. Addressing Patient Emotional and Existential Needs During Serious Illness: Results of the Outlook Randomized Controlled Trial. J Pain Symptom Manag. 2017;54(6):898–908. Steinhauser KE, Alexander SC, Byock IR, George LK, Olsen MK, Tulsky JA. Do preparation and life completion discussions improve functioning and quality of life in seriously ill patients? Pilot randomized control trial. J Palliat Med. 2008;11(9):1234–40. Keall RM, Butow PN, Steinhauser KE, Clayton JM. Nurse-facilitated preparation and life completion interventions are acceptable and feasible in the Australian palliative care setting: results from a phase 2 trial. Cancer Nurs. 2013;36(3):E39–46. Saeedi B, Khoshnood Z, Dehghan M, Abazari F, Saeedi A. The Effect of Positive Psychotherapy on the Meaning of Life in Patients with Cancer: A Randomized Clinical Trial. Indian J Palliat Care. 2019;25(2):210–7. Trakoolngamden B, Monkong S, Chaiviboontham S, Satitvipawee P, Runglodvatana Y. Effect of a Peaceful End-of-Life Care Program on Perceived Good Death in People With Advanced Cancer and Their Family Caregivers. J hospice Palliat nursing: JHPN : official J Hospice Palliat Nurses Association. 2025;27(2):94–101. Ando M, Morita T, Akechi T, Okamoto T. Efficacy of short-term life-review interviews on the spiritual well-being of terminally ill cancer patients. J Pain Symptom Manag. 2010;39(6):993–1002. Li XM, Chen LZ, Liu DM. Effects of online-offline integrated death education on patients with advanced cancer: A before-and-after study. Eur J Oncol nursing: official J Eur Oncol Nurs Soc. 2023;67:102433. Philipp R, Mehnert A, Müller V, Reck M, Vehling S. Perceived relatedness, death acceptance, and demoralization in patients with cancer. Supportive care cancer: official J Multinational Association Supportive Care Cancer. 2020;28(6):2693–700. Staats K, Svendsen SJ, Lockertsen V. Navigating toward acceptance of death: Home-dwelling patients in the palliative phase. BMC Palliat care. 2025;24(1):71. Miller-Lewis L, Tieman J, Rawlings D, Parker D, Sanderson C. Can Exposure to Online Conversations About Death and Dying Influence Death Competence? An Exploratory Study Within an Australian Massive Open Online Course. Omega. 2020;81(2):242–71. Kirsten Toro K, Rebolledo-Sanhueza J, Aliaga-Castillo V, Acuña Rojas J, Bascuñán Rodríguez ML, Briceño González R, Cornejo Guerrero MC, Huepe-Ortega G. [Preparation for Death and Its Clinical Implications: A Narrative Review]. Rev Med Chil. 2025;153(3):225–35. Berlin P, Leppin N, Nagelschmidt K, Seifart C, Rief W, von Blanckenburg P. Development and Validation of the Readiness for End-of-Life Conversations (REOLC) Scale. Front Psychol. 2021;12:662654. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 06 Feb, 2026 Editor invited by journal 12 Jan, 2026 Editor assigned by journal 03 Dec, 2025 Submission checks completed at journal 02 Dec, 2025 First submitted to journal 02 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8211775","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588092942,"identity":"2faf18da-df74-4589-bb42-15b0b1bf9c73","order_by":0,"name":"xinyu ju","email":"","orcid":"","institution":"Jiangxi Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"xinyu","middleName":"","lastName":"ju","suffix":""},{"id":588092943,"identity":"19284f32-9ac3-4966-a7c3-9557fed1c739","order_by":1,"name":"zhaomeng zhang","email":"","orcid":"","institution":"Jiangxi Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"zhaomeng","middleName":"","lastName":"zhang","suffix":""},{"id":588092944,"identity":"45ecdf2e-8fd5-4213-9b17-8da8a3f8118d","order_by":2,"name":"yujin zhang","email":"","orcid":"","institution":"Jiangxi Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"yujin","middleName":"","lastName":"zhang","suffix":""},{"id":588092945,"identity":"8bd1b179-6bd3-43f9-96a9-aa575cf18da0","order_by":3,"name":"Jinhua Hong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYBACNv7G9o8feGzk2NibDz5IqKghrIVP4nAbs4RMmjEfz7FkgwdnjhHWIseQ3sbAY3M4cZ5EjprkwxZmIhzGcLDtgUROmjGbRA5bRWIDGwN/e3cCfi3Mje0GBWeAfuF5e+xG4g4ZBokzZzcQsqVBQrIHaAt7XtqNxDNsDAYSuYS0JDZI8P47nNjGkGNWkNjGTJSWNgkeHqAWjhwzBuK0SBxsNpbgAToMGMgSCWeO8RD0i3x/+8OHoKiUb28++PFHRY0cf3svfi0YgIc05aNgFIyCUTAKsAIAYp9I6qAGE4wAAAAASUVORK5CYII=","orcid":"","institution":"Jiangxi Cancer Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jinhua","middleName":"","lastName":"Hong","suffix":""}],"badges":[],"createdAt":"2025-11-26 10:23:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8211775/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8211775/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102440293,"identity":"93b3f556-dccc-4e29-973f-51a5d7b1e332","added_by":"auto","created_at":"2026-02-11 16:46:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":42323,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLiterature Screening Flowchart\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8211775/v1/66f28483a9fd80824b4c4a46.png"},{"id":102745929,"identity":"ad5e270f-cc83-43a1-9519-f139cd2e3a80","added_by":"auto","created_at":"2026-02-16 08:54:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":61420,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDefinition, Influencing Factors, Assessment Tools, and Interventions for Death Preparation\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8211775/v1/ebe042242c16c384862eb602.png"},{"id":103504014,"identity":"63969a04-6105-4bc3-856c-f5ee082be8d0","added_by":"auto","created_at":"2026-02-26 13:07:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1315839,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8211775/v1/c1457ece-a199-4292-a821-7c7704d90062.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Type of contribution:Scoping Review Death Readiness among Terminally Ill Patients: A Scoping Review","fulltext":[{"header":"1 Background","content":"\u003cp\u003eIn recent years, the global incidence of malignant tumors has continued to rise, making cancer one of the leading causes of mortality and morbidity worldwide. According to data released by the World Health Organization's International Agency for Research on Cancer (IARC), approximately 19.29\u0026nbsp;million new cancer cases were diagnosed globally in 2020, with close to 9.96\u0026nbsp;million deaths attributed to the disease[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].As a country with a high cancer incidence, China accounts for a relatively high proportion of both new cancer cases and cancer-related deaths globally, posing severe challenges to cancer prevention and control. Notably, most patients are already at the moderate to advanced stage at the time of diagnosis. When the disease progresses to the terminal stage, they often confront multifaceted suffering, including physical, psychological, and social dimensions[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].As the final phase of disease progression, the terminal stage in end-of-life care presents an urgent question that demands exploration: how to ensure a peaceful passing for terminally ill patients[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].Additionally, with societal progress and improving living standards, people are gradually paying more attention to and pursuing the quality of life and the quality of death, making it imperative to enhance death preparedness for patients with advanced cancer[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].Research indicates that a good death requires both patients and caregivers to have a high level of preparedness for death.Therefore, enhancing death readiness among patients with advanced cancer is imperative[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDeath preparation refers to an individual's psychological, cognitive, behavioral, and social readiness for death during the terminal phase of life. Research indicates that effective death preparation holds significant importance for patients, families, and society at large. For patients, thorough death preparation helps alleviate death anxiety and stress, fosters a more positive perception of death, reduces unnecessary medical interventions, and enhances quality of life during the final stages of life[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].For family caregivers, preparing for death can alleviate the burden of decision-making and the pain of bereavement, while preventing family conflicts arising from poor communication[\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].From the perspective of the healthcare system, enhancing end-of-life preparation helps optimize resource allocation and improve the efficiency and quality of compassionate care in terminal stages[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].Therefore, death preparation is not only a psychological adaptation process at the individual patient level but also an integral part of the overall palliative care system.\u003c/p\u003e \u003cp\u003eCurrently, research on end-of-life preparedness among terminally ill patients has yielded relevant reviews and systematic evaluations of intervention measures[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, there are still some problems, such as unclear definition of concepts, unsystematic clarification of influencing factors, relatively limited evaluation tools, diverse intervention measures and scattered evidence, and a systematic and integrated knowledge framework has not yet been formed[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In order to sort out the research status in this field, integrate the existing evidence and clarify the future research direction, it is of great theoretical value and practical reference significance to carry out a review of the concept connotation, influencing factors, evaluation tools and intervention strategies of death readiness of dying patients.\u003c/p\u003e \u003cp\u003eScope review methods are suitable for systematically organizing knowledge in complex and under-explored research domains[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].This study conducted a systematic review to synthesize and analyze existing literature on the concept of death readiness in terminally ill patients, its influencing factors, relevant assessment tools, and associated intervention measures.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cp\u003eThis study utilised Arksey and O'Malley's framework[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]to conduct a scoping review in order to systematically search, select and synthesise existing knowledge. The framework consists of several key stages: identifying the research question, identifying relevant studies, selecting studies, charting the data, and collating, summarising, and reporting the results. The PRISMA extension (PRISMA-ScR) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]for scoping reviews was followed in this study.Ethical approval was not required for this review of the existing literature.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Stage 1: Identifying the Research Question\u003c/h2\u003e \u003cp\u003eThe research questions identified to address the objectives of this scoping review are as follows:\u003c/p\u003e \u003cp\u003e①What are the primary factors influencing end-of-life preparedness among terminally ill patients?\u003c/p\u003e \u003cp\u003e②What are the assessment tools for end-of-life preparedness and how are they utilized?\u003c/p\u003e \u003cp\u003e③What interventions exist to address end-of-life preparedness among terminally ill patients?\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Stage 2: Identifying Relevant Studies\u003c/h2\u003e \u003cp\u003eComputerized searches were conducted in PubMed, The Cochrane Library, MEDLINE, Embase, CINAHL, Web of Science, the Chinese Biomedical Literature Database, and China National Knowledge Infrastructure (CNKI). The search time span was set from the inception of each database to May 13, 2025. The search strategy combined subject headings with free-text terms. Example PubMed search strategy: \u0026ldquo;Death Preparation\u0026rdquo;[Title/Abstract] OR \u0026ldquo;Death Preparedness\u0026rdquo;[Title/Abstract] OR \u0026ldquo;Death planning\u0026rdquo;[Title/Abstract] OR \u0026ldquo;end of life preparedness\u0026rdquo;[Title/Abstract] OR \u0026ldquo;end of life preparation\u0026rdquo;[Title/Abstract] OR \u0026ldquo;Death readiness\u0026rdquo;[Title/Abstract]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Stage 3: Literature Inclusion and Exclusion Criteria\u003c/h2\u003e \u003cp\u003eInclusion Criteria: ①Study subjects were terminally ill patients or their primary caregivers, aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years; ②Study topics involved factors influencing death preparedness, assessment tools, or interventions; ③Literature type was original research.\u003c/p\u003e \u003cp\u003eExclusion Criteria: ①Literature not reported in Chinese or English; ②Literature with unavailable full text, duplicate publications, incomplete data, or low quality; ③Reviews, case reports, experimental protocols, opinion pieces, etc.\u003c/p\u003e \u003cp\u003eDeduplication performed using NoteExpress software. Titles and abstracts of all studies were initially screened against inclusion and exclusion criteria. Full texts of preliminarily selected studies underwent comprehensive eligibility assessment. Two independent reviewers conducted this screening. Disagreements were resolved through discussion or consultation with a third reviewer. The selection process is illustrated in the flowchart (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Stage 4: Data Extraction and Charting\u003c/h2\u003e \u003cp\u003eA customized data extraction table was developed to systematically collect and organize key information from the selected literature. This included authors, publication dates, countries, study types, sample sizes, intervention durations, assessment metrics, influencing factors, and research themes. To facilitate comparative analysis with English-language studies, data extracted from Chinese research were translated into English. Two reviewers independently extracted data from each included article, with any discrepancies resolved through discussion with a third researcher. No formal assessment of methodological quality or reliability was conducted, as this fell outside the scope of this review.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study Characteristics of Included Literature\u003c/h2\u003e \u003cp\u003eThe included literature was published from 2009 to 2025, and the research sites were distributed in the United States ( n\u0026thinsp;=\u0026thinsp;5 ), China ( n\u0026thinsp;=\u0026thinsp;3 ), China 's Taiwan ( n\u0026thinsp;=\u0026thinsp;1 ), Canada ( n\u0026thinsp;=\u0026thinsp;1 ), Kenya ( n\u0026thinsp;=\u0026thinsp;1 ), India ( n\u0026thinsp;=\u0026thinsp;1 ), Japan ( n\u0026thinsp;=\u0026thinsp;1 ), Spain ( n\u0026thinsp;=\u0026thinsp;2 ), Australia ( n\u0026thinsp;=\u0026thinsp;1 ), and Thailand ( n\u0026thinsp;=\u0026thinsp;1 ). Research type : 1 cross-sectional study, 1 longitudinal study, 3 mixed studies, 1 cohort study, 1 qualitative study, 10 intervention studies. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the characteristics of the included studies.The basic characteristics of the included literature are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003eand the definition, influencing factors, assessment tools and interventions of death preparation are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral information of the included studies(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eType of study\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eResearch object\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIntervention methods\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eIntervention frequency / duration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eEvaluation tools\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eInfluencing factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsatsa et al.\u003c/p\u003e \u003cp\u003e(2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ecombining cross-sectional and phenomenological designs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003enon-clinical residents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ethe Death Attitude Profile-Revised(DAP-R)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003edeath attitudes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTo explore the predictive effect of death attitudes on death preparedness among non-clinical populations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCicirelli et al.\u003c/p\u003e \u003cp\u003e(2011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMixed-methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eelders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ethe Death Attitude Profile-Revised(DAP-R);\u003c/p\u003e \u003cp\u003ethe Life Attitude Profile-Revised(LAP-R)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ereligious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTo explore the effects of religious and nonreligious spirituality on attitudes toward 'death acceptance' and 'death rejection' among elders\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMah et al.\u003c/p\u003e \u003cp\u003e(2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLongitudinal study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePatients with advanced cancer and partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eDeath Preparation Scale (DPS)\u003c/p\u003e \u003cp\u003ethe validated Quality of Life at the End of Life (QUAL-E)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ecouple communication\u003c/p\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTo explore how attachment security influences death preparation in patients with advanced cancer, and whether couple communication mediates this relationship\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWen et al.\u003c/p\u003e \u003cp\u003e(2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTaiwan Region of China\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdvanced cancer patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ethe validated Quality of Life at the End of Life (QUAL-E)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003eYears\u003c/p\u003e \u003cp\u003efinancial hardship\u003c/p\u003e \u003cp\u003edisease burden\u003c/p\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003cp\u003eprognostic disclosure\u003c/p\u003e \u003cp\u003epatient-family communication\u003c/p\u003e \u003cp\u003esocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTo explore the factors associated with death preparedness states in cancer patients\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiranda-D\u0026iacute;az et al.\u003c/p\u003e \u003cp\u003e(2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCross-sectional study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eelderly population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eDeath Anxiety Scale (DAS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCultural\u003c/p\u003e \u003cp\u003ereligious\u003c/p\u003e \u003cp\u003eemotional aspects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eto compare the levels of death anxiety, fear of death, attitudes towards death and associated emotional aspects (anxiety and depression) in older adults from 2different cultures, Western and Arab\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZhang et al.\u003c/p\u003e \u003cp\u003e(20250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExploratory mixed-methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eadvanced cancer patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eTo develop measurement tool for death preparedness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePreparation for Final Passing-Revised (PFP-R)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZhang et al.\u003c/p\u003e \u003cp\u003e(2025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQualitative Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 advanced cancer patients, 11 family members, 16 nurses and 4 doctors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCognitive Dimension Affective Dimension、Behavioral Dimension、Social Dimension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTo develop a model of death preparedness in patientswith advanced cancer\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGil et al.\u003c/p\u003e \u003cp\u003e(2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecancer inpatients in the end\u0026nbsp;of\u0026nbsp;life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eMeaning-centered psychotherapy integrated with elements of compassion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 sessions, approximately 45\u0026ndash;60 minutes per session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eThe Feasibility, acceptability, and utility for the pre- and posttreatment questionnaires\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003emeaning, self-compassion, compassion, legacy, and courage and commitment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSteinhauser et al.\u003c/p\u003e \u003cp\u003e(2009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHospice-eligible subjects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eOutlook intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 sessions, approximately 45\u0026ndash;60 minutes per session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ethe Quality of Life at the End of Life(QUAL-E)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eThe impact of 'Preparation and Life Completion' on patients' function, emotions, and death preparedness in at the end of life\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSteinhauser et al.\u003c/p\u003e \u003cp\u003e(2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eseriously ill patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eOutlook intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 sessions, approximately 45\u0026ndash;60 minutes per session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ethe Quality of Life at the End of Life(QUAL-E)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTo investigate the effect of Outlook Intervention on addressing patients' emotional and existential needs during serious illness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSteinhauser et al.\u003c/p\u003e \u003cp\u003e(2008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eseriously ill patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eOutlook intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 sessions, approximately 45\u0026ndash;60 minutes per session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ethe Quality of Life at the End of Life(QUAL-E)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTo examine whether discussions on ' promotes discussions of end-of-life preparation and completion ' improve function and quality of life in patients with serious illness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKeall et al.\u003c/p\u003e \u003cp\u003e(2013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epalliative care patients with advanced cancer or other life-threatening illnesses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eOutlook intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 sessions, approximately 45\u0026ndash;60 minutes per session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ethe Quality of Life at the End of Life(QUAL-E)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eto explore the acceptability and feasibility of a nurse-facilitated preparation and life completion intervention (Outlook) in an Australian palliative care patient population.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSaeedi et al.\u003c/p\u003e \u003cp\u003e(2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epatients with cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eThe positive psychotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eeight 90-min sessions held weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ethe Life Attitude Profile-Revised (LAP-R)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eto investigate the effect of positive psychotherapy on understanding the meaning of life in patients with cancer.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrakoolngamden et al.\u003c/p\u003e \u003cp\u003e(2025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThailand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQuasi-experimental Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eadvanced cancer and their family caregivers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003ea peaceful end-of-life care program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4 weeks, 45\u0026ndash;60 min/session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eto examine the effect of a peaceful end-of-life care program on perceived good death outcomes in people with advanced cancer and their family caregivers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSong et al.\u003c/p\u003e \u003cp\u003e(2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epatients receiving dialysis and their families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eSPIRIT ACP intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45\u0026thinsp;~\u0026thinsp;60min discussions in the clinic or remotely, A short-term follow-up can be conducted after 2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTo explore the effectiveness of advance care planning (ACP) strategies for patients receiving dialysis and their families\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAndo et al.\u003c/p\u003e \u003cp\u003e(2010)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJapan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntervention Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epatients with advanced cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eShort-Term Life Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTwice a week, approximately 60 minutes per session, for 1 consecutive week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTo verify the enhancing effect of short-term life review on spiritual well-being, anxiety/depression, and 'good death' elements in patients with advanced cancer\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLi et al.\u003c/p\u003e \u003cp\u003e(2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA before-and-after study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epatients with advanced cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eonline-offline integrated death education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ein a 4-week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ethe Life Attitude Profile-Revised (LAP-R);\u003c/p\u003e \u003cp\u003eTempler's Death Anxiety Scale, (DAS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026mdash;\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTo evaluate the Effects of online-offline integrated death education on patients with advanced cancer\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Factors Influencing End-of-Life Readiness in Terminally Ill Patients\u003c/h2\u003e \u003cp\u003eAmong the five studies examining relevant influencing factors, it was found that most domestic and international research on factors affecting end-of-life preparedness among terminally ill patients primarily focused on three areas: demographic factors, environmental factors, and individual factors.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIndividual Factors\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThese include attitudes toward death, disclosure of prognosis, and religious beliefs. One study[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]indicated that attitudes toward death are associated with preparedness for death. One study[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] demonstrated that disclosure of prognosis is related to preparedness for death. Two studies [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] revealed that religious beliefs correlate with preparedness for death.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEnvironmental Factors\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIncludes communication between patients and families, social support, and cultural differences. Two studies[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]indicate that communication between patients and family members correlates with levels of death preparedness, and that attachment security can support death preparedness in advanced cancer through improved spousal communication. One study [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] demonstrates that social support is associated with death preparedness. One study[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] shows that cultural differences influence family communication and levels of death preparedness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Assessment Tools for Death Readiness in Terminally Ill Patients\u003c/h2\u003e \u003cp\u003eCurrently, there are no universally recognized assessment tools or standards for evaluating death readiness in terminally ill patients. Included assessment tools comprise the Quality of Life at the End of Life (QUAL-E)[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], the Death Anxiety Scale (DAS)[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], the Death Attitude Profile-Revised (DAP-R)[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], the Life Attitude Profile-Revised (LAP-R)[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and the Preparation for the Future Professional Scale-Revised (PFP-R)[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Interventions, Evaluation Indicators, and Outcomes for Death Readiness in Terminally Ill Patients\u003c/h2\u003e \u003cp\u003eThe interventions included in the 10 studies comprised Meaning-centered positive psychological intervention, palliative care treatment, reminiscence therapy, and death education.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe effect of ' meaning-centered ' positive psychological intervention\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSix studies[\u003cspan additionalcitationids=\"CR28 CR29 CR30 CR31\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]primarily implemented psychotherapy, specifically an intervention combining meaning-centered psychotherapy with compassion elements. This intervention was administered to 30 cancer patients. Results showed no significant differences between treatments, but patients reported the most useful elements or structures as meaning, self-compassion, compassion, legacy, and courage and commitment[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Four studies designed the Outlook intervention, incorporating life stories, forgiveness, and legacy. Results consistently demonstrated that the Outlook intervention provides a brief, standardized, and portable approach to improving quality of life for patients with advanced serious illnesses [\u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, one study noted that compared to standard care interventions, Outlook influenced social well-being and preparedness but had no effect on anxiety or depression and showed no significant benefit for individuals not experiencing existential or emotional distress[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. One study employed positive psychotherapy through eight 90-minute weekly group sessions with 61 cancer patients. Results indicated that positive psychotherapy effectively enhanced patients' levels of meaningful living, enjoyment, and life commitment[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eEffectiveness of Palliative Care Interventions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTwo studies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] primarily implemented palliative care interventions. One study designed a 4-week program based on standard care, incorporating health education, symptom management self-care, advance care planning, psychosocial support, and family involvement. Results demonstrated significant improvements in the intervention group regarding perceived good death, quality relationships, and palliative care knowledge[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Another study employed a pre-care planning intervention guided by the structured SPIRIT framework, demonstrating that implementing pre-care planning improved preparedness for end-of-life decision-making[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eEffects of Other Intervention Methods\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe remaining two studies[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] employed retrospective therapy and death education. One study employed short-term life review therapy, demonstrating that brief life review effectively improved mental health, reduced psychosocial distress, and promoted a good death among patients with advanced cancer[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Another study designed a 4-week blended online-offline death education program, which enhanced participants' capacity to confront death while also helping family members prepare psychologically and physically for the loss of a loved one[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.1 There are many factors affecting the death preparation\u003c/h2\u003e \u003cp\u003e \u003cb\u003eDemographic Factors\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDemographic factors include age, gender, economic status, and disease burden. Multiple studies[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] indicate that older terminally ill patients exhibit relatively higher death readiness. Wen et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] showed that age growth was positively correlated with emotional acceptance and preparation for death, but negatively correlated with the level of accurate prognostic awareness. The reason for the analysis is that the death of the elderly is regarded as the law of nature, while the early death is contrary to filial piety and life expectations, so the emotional preparation of the elderly for death is relatively sufficient. At the same time, under the concept of Confucian filial piety, children return and protect their elderly parents, resulting in ' protective concealment ', but may reduce the patient 's right to know and independent decision-making ability, resulting in insufficient cognitive preparation, consistent with Zhang et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]qualitative research results. Therefore, medical staff should actively communicate with the patient 's family members, indicating that moderate informing the prognosis is helpful for the patient to arrange follow-up matters, and it is recommended that the communication process can be used in a gradual manner, according to the patient 's emotional state to disclose information in batches, and maintain sufficient emotional support throughout the process. Studies have shown that men are more likely to be emotionally prepared and fully prepared than women, and that men generally have better quality of communication between husband and wife than women[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This may be related to the role expectations and coping styles given by society. For example, in traditional culture, men assume the role of family decision-making and are encouraged to suppress emotions to maintain family harmony, while women are more likely to be affected by attachment anxiety because they pay more attention to communication. Therefore, nursing staff can provide personalized psychological intervention, strengthen their decision-making role for men, help them accept death and plan for future events, and provide emotional support for women, encouraging the expression of concerns and fears. Wen et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] showed that cancer patients with economic difficulties and painful symptoms were negatively correlated with the emotional state and full preparation for death. The reason for this analysis is that as pain and other physical symptoms accelerate, patients may be too afraid to participate in fears about their own and their families ' futures, thus impeding death preparation[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. At the same time, financial stress can increase patients ' psychological distress and may also limit their access to adequate medical resources and social support, which in turn affects their emotional and full readiness for death. Therefore, it is recommended that standardized symptom assessment be used as an opportunity to start an advance care plan. On the basis of effectively alleviating pain and building trust, patients should be guided to express their willingness and values for future medical care when symptoms are controllable, and their economic pressure should be evaluated simultaneously. Provide practical resource assistance, so as to systematically transform clinical care into nursing practice that improves patients ' cognitive and emotional readiness.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIndividual Factors\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIndividual factors include attitudes toward death, prognosis disclosure, religious beliefs, and others. Asatsa et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]used a mixed method sequential design to select 335 participants of different age groups through multi-stage sampling. It was found that negative death attitudes decreased with age, and positive death attitudes increased with age, which in turn affected death readiness. The negative death attitude stems from death threats, unmet goals, etc., and the positive attitude is due to the reunion of relatives and friends. Therefore, medical staff can carry out life education lectures or group counseling for young people to help them alleviate the fear of death ; at the same time, the elderly are encouraged to strengthen the family connection by writing memoirs and family story meetings, so as to improve the psychological preparation of different age groups for the end of life. Wen et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] have shown that doctors ' prognosis disclosure can increase the possibility of patients being in a cognitive state and fully prepared. The reason is that doctors ' prognosis disclosure allows patients to better understand their own conditions, so as to better prepare for death cognitively and emotionally. It is consistent with the results of the second study of Staats et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Therefore, it is recommended to encourage medical staff to actively provide patients with clear prognostic information and give psychological support. Cicirelli [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]Studies have shown that the concept of the afterlife of religious beliefs helps to improve the death readiness of the elderly, and non-religious elderly people are more willing to accept life extension and rejection of death. The reason for the analysis is that non-religious beliefs emphasize more on personalized meaning construction, so that individuals seek opportunities to prolong life and refuse death. It is recommended that medical staff fully respect the patient 's religious background, evaluate the individual 's value system, and find adaptive psychological intervention methods for the reconstruction of life meaning, so as to effectively improve the patient 's death preparation level.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEnvironmental Factors\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFamily social environment factors, including communication between patients and their families, social support, cultural differences, etc. For families of dying patients, talking about death is difficult, and reduced family communication often leads to increased uncertainty, with adverse effects on patients and their families. The results of two [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]studies showed that communication between dying patients and their families on end-of-life issues was helpful to improve the readiness for death of both parties. The analysis of the reasons for the discussion of end-of-life and death-related issues between patients and their spouses could narrow the gap between the two sides on end-of-life issues, promote the sharing of their own feelings, and thus reduce the degree of pain. Therefore, it is recommended that nursing staff carry out structured family communication interventions, such as guiding families to participate in family dignity therapy or couple communication skills to guide death topics, and promote frank communication about dying intentions in a safe atmosphere. Wen et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]have shown that high social support increases emotional preparation, but cognitive preparation may be weakened, and family members may selectively conceal prognostic information to protect patients, thus weakening their cognitive preparation. Therefore, on the basis of respecting the willingness of family emotional protection, nursing staff should guide family members to realize the importance of moderate information sharing to patients ' independent decision-making, and suggest that family members can adopt progressive information disclosure strategy to inform the patient 's condition in stages according to the patient 's psychological tolerance, so as to help the family seek a balance between emotional support and cognitive preparation. Miranda-D\u0026iacute;az et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]found that in collectivist cultures, religious identity as a social norm may indirectly strengthen fear of death through the mediating role of depression, which emphasizes the cultural specificity of the emotional regulation path of death anxiety. The reason is that when patients regard religious norms as group norms that must be observed, they are prone to feel ashamed of being unable to meet the standards, and at the same time suppress their true feelings in order to maintain group harmony. This inner contradiction will aggravate emotional distress.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Limitations in the Uniformity and Applicability of Death Readiness Assessment Tools\u003c/h2\u003e \u003cp\u003eIn previous studies on death readiness of dying patients, the assessment tool has a single lack of multi-dimensional assessment of death readiness. For example, the Quality of Life at the End of Life ( QUAL-E ) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]provides a comprehensive assessment, and has good reliability and validity, but it focuses more on quality of life rather than death readiness, and patient self-reporting may be inaccurate. The Death Anxiety Scale ( DAS ) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] can effectively assess the degree of death anxiety, but the direct correlation with death readiness is weak, and it is limited by a single dimension and cannot capture complex emotions. The Death Attitude Profile-Revised ( DAP-R ) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] is a multi-dimensional psychological assessment, which can fully understand the patient 's attitude towards death, but some dimensions may have poor cultural adaptability, and the items may not be suitable for certain cultural backgrounds. The revised Life Attitude Profile-Revised ( LAP-R ) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] can comprehensively assess the patient 's attitude towards life and death, and provide a certain reference for understanding the patient 's readiness for death. However, the scale mainly focuses on life attitude, and the direct correlation with the readiness for death is weak, so it cannot accurately measure the patient 's specific readiness for death. The Preparation for the Future Professional Scale-Revised ( PFP-R ) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]is specifically developed for patients with advanced cancer, but has not been fully validated in other end-stage populations such as chronic organ failure and neurodegenerative diseases. In view of the limitations of the above assessment tools, it is suggested that future research should focus on the construction of localized multi-dimensional assessment tools in line with Chinese culture, and integrate multiple dimensions such as cognition, emotion, behavior and social culture to comprehensively assess the level of death preparedness of dying patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.3 The simplification of death preparation intervention model is difficult to cope with multidimensional needs.\u003c/h2\u003e \u003cp\u003eBased on the results of included studies, we found that interventions can significantly improve patients' end-of-life preparedness. For instance, meaning-centered therapy[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], the Outlook intervention [\u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and death education[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] enhance readiness by strengthening the sense of life meaning and social well-being. Over time, death readiness significantly increased among participants in death education programs[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].In summary, all studies have reported positive results in the dimension of death preparation, confirming the effectiveness of intervention. However, there is still a lack of standardized assessment tools for the outcome indicators of intervention measures in the assessment of death preparation, and the current intervention has limitations such as single focus and insufficient individual adaptation, which is difficult to fully meet the needs of patients[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In addition, the study found that the degree of death acceptance of patients showed significant individual differences and time-varying characteristics, which required that the intervention program must have sufficient flexibility and responsiveness[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In view of the dispersion and single-dimensional limitations of current death preparation interventions, future research should focus on building an integrated intervention system. The system should be based on standardized multi-dimensional assessment tools, accurately identify the specific needs of patients in multiple dimensions, and integrate artificial intelligence clinical decision support system. By analyzing the patient 's physiological indicators and psychological state data, it provides a basis for personalized matching of intervention strategies. According to the evaluation results and the changes of patients ' disease stage, cultural background and preparation degree, a dynamic adjustment mechanism is established to finally realize the transformation from standardized intervention to precise support, and comprehensively improve the quality of death preparation for patients with advanced cancer.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Limitations\u003c/h2\u003e \u003cp\u003eThere are some limitations in this study. First of all, as a scope review, there is no methodological quality assessment of the included literature, and the strength of the evidence for the conclusion needs to be carefully considered. Secondly, although the retrieval strategy covers both Chinese and English databases, all the included literatures ( n\u0026thinsp;=\u0026thinsp;17 ) are finally published in English, with potential language and publication bias, which may not fully integrate the relevant research in the Chinese context, especially the lack of reflection on the local practice and cultural perspective of mainland China. Therefore, the influencing factors, assessment tools and intervention strategies summarized in this paper are mainly based on the evidence under the international academic discourse system, and their ability to directly apply to the clinical and cultural environment of China is limited. Thirdly, the number of included studies is small, and the heterogeneity of cultural background is high, which limits the integration depth and external generalization of the results. These limitations suggest that this review mainly reviews the relevant research in the international English literature in this field, and has an important reference for the future development of localized and contextualized high-quality death preparation research for dying patients in China.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Summary","content":"\u003cp\u003eThis scope review systematically reviews the research status of death readiness of dying patients, and clarifies that death readiness includes four aspects : psychology, cognition, behavior and society. The research summarizes its main influencing factors, including demographic characteristics, individual psychological state and environmental support. The existing assessment tools are mostly focused on the psychological and attitude dimensions, and there is still a lack of integrated localized multi-dimensional tools. Interventions involve various forms such as positive psychotherapy, advance medical plans, and death education, but a systematic and individualized integration plan has not yet been formed. In the future, a multi-dimensional evaluation system suitable for Chinese culture should be constructed, and a comprehensive intervention model based on empirical and dynamic adaptation should be developed, so as to improve the level of death preparation of dying patients and promote them to achieve good death.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSubmitted for review and possible publication in\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003eBMC Palliative Care\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHong Jinhua (H.J.) led the study conceptualization, methodology, and original draft preparation. Zhang Zhaomeng (Z.Z.) and Yu Xinyu (Y.X.) contributed to literature screening, data extraction, and analysis. Zhang Yujin (Z.Y.) supervised the project and provided critical revisions. All authors reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. Cancer J Clin. 2021;71(3):209\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChua GP, Pang GSY, Yee ACP, Neo PSH, Zhou S, Lim C, Wong YY, Qu DL, Pan FT, Yang GM. 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O'malley LJIjosrm: Scoping studies: towards a methodological framework. 2005, 8(1):19\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MD, Horsley T. Weeks LJAoim: PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. 2018, 169(7):467\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsatsa S. Death Attitudes as Possible Predictors of Death Preparedness across Lifespan among Nonclinical Populations in Nairobi County, Kenya. Indian J Palliat Care. 2020;26(3):287\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWen FH, Hsieh CH, Chou WC, Su PJ, Hou MM, Shen WC, Chen JS, Chang WC, Tang ST. Factors associated with cancer patients' distinct death-preparedness states. Psycho-oncology. 2023;32(7):1048\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCicirelli VG. Religious and nonreligious spirituality in relation to death acceptance or rejection. Death Stud. 2011;35(2):124\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiranda-D\u0026iacute;az S, Hassan BH, Fern\u0026aacute;ndez-Alc\u0026aacute;ntara M, Garc\u0026iacute;a-Caro MP. [Attitudes and anxiety towards death in elderly people from 2different cultures: Spain and Egypt]. \u003cem\u003eRevista espanola de geriatria y gerontologia\u003c/em\u003e 2022, 57(3):168\u0026ndash;173.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMah K, Shapiro GK, Hales S, Rydall A, Malfitano C, An E, Nissim R, Li M, Zimmermann C, Rodin G. The impact of attachment security on death preparation in advanced cancer: The role of couple communication. Psycho-oncology. 2020;29(5):833\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang X, Wei X, Zhao M, Zeng T, Chen Y. Death Preparedness Scale for Advanced Cancer Patients: Instrument Development and Psychometric Properties. \u003cem\u003ePsycho-oncology\u003c/em\u003e 2025, 34(4):e70149.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGil F, Fraguell C, Benito L, Casellas-Grau A, Limonero JT. Meaning-centered psychotherapy integrated with elements of compassion: A pilot study to assess feasibility and utility. Palliat Support Care. 2018;16(6):643\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinhauser KE, Alexander SC, Byock IR, George LK, Tulsky JA. Seriously ill patients' discussions of preparation and life completion: an intervention to assist with transition at the end of life. Palliat Support Care. 2009;7(4):393\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinhauser KE, Alexander S, Olsen MK, Stechuchak KM, Zervakis J, Ammarell N, Byock I, Tulsky JA. Addressing Patient Emotional and Existential Needs During Serious Illness: Results of the Outlook Randomized Controlled Trial. J Pain Symptom Manag. 2017;54(6):898\u0026ndash;908.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinhauser KE, Alexander SC, Byock IR, George LK, Olsen MK, Tulsky JA. Do preparation and life completion discussions improve functioning and quality of life in seriously ill patients? Pilot randomized control trial. J Palliat Med. 2008;11(9):1234\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeall RM, Butow PN, Steinhauser KE, Clayton JM. Nurse-facilitated preparation and life completion interventions are acceptable and feasible in the Australian palliative care setting: results from a phase 2 trial. Cancer Nurs. 2013;36(3):E39\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaeedi B, Khoshnood Z, Dehghan M, Abazari F, Saeedi A. The Effect of Positive Psychotherapy on the Meaning of Life in Patients with Cancer: A Randomized Clinical Trial. Indian J Palliat Care. 2019;25(2):210\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrakoolngamden B, Monkong S, Chaiviboontham S, Satitvipawee P, Runglodvatana Y. Effect of a Peaceful End-of-Life Care Program on Perceived Good Death in People With Advanced Cancer and Their Family Caregivers. J hospice Palliat nursing: JHPN : official J Hospice Palliat Nurses Association. 2025;27(2):94\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndo M, Morita T, Akechi T, Okamoto T. Efficacy of short-term life-review interviews on the spiritual well-being of terminally ill cancer patients. J Pain Symptom Manag. 2010;39(6):993\u0026ndash;1002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi XM, Chen LZ, Liu DM. Effects of online-offline integrated death education on patients with advanced cancer: A before-and-after study. Eur J Oncol nursing: official J Eur Oncol Nurs Soc. 2023;67:102433.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhilipp R, Mehnert A, M\u0026uuml;ller V, Reck M, Vehling S. Perceived relatedness, death acceptance, and demoralization in patients with cancer. Supportive care cancer: official J Multinational Association Supportive Care Cancer. 2020;28(6):2693\u0026ndash;700.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStaats K, Svendsen SJ, Lockertsen V. Navigating toward acceptance of death: Home-dwelling patients in the palliative phase. BMC Palliat care. 2025;24(1):71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller-Lewis L, Tieman J, Rawlings D, Parker D, Sanderson C. Can Exposure to Online Conversations About Death and Dying Influence Death Competence? An Exploratory Study Within an Australian Massive Open Online Course. Omega. 2020;81(2):242\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKirsten Toro K, Rebolledo-Sanhueza J, Aliaga-Castillo V, Acu\u0026ntilde;a Rojas J, Bascu\u0026ntilde;\u0026aacute;n Rodr\u0026iacute;guez ML, Brice\u0026ntilde;o Gonz\u0026aacute;lez R, Cornejo Guerrero MC, Huepe-Ortega G. [Preparation for Death and Its Clinical Implications: A Narrative Review]. Rev Med Chil. 2025;153(3):225\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerlin P, Leppin N, Nagelschmidt K, Seifart C, Rief W, von Blanckenburg P. Development and Validation of the Readiness for End-of-Life Conversations (REOLC) Scale. Front Psychol. 2021;12:662654.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8211775/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8211775/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo conduct a comprehensive review of relevant studies on the readiness for death of terminally ill patients at home and abroad, and systematically analyze their influencing factors, assessment tools, and intervention strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign: \u003c/strong\u003eScoping review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData sources: \u003c/strong\u003eSystematic searches were performed in two Chinese databases (CNKI, Chinese Biomedical Literature Database) and six English databases (PubMed, Cochrane Library, MEDLINE, Embase, Web of Science, CINAHL) from their inception until May 13, 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e Two reviewers independently retrieved full-text studies and conducted the initial screening of titles and abstracts, followed by full-text analysis and data extraction. In case of any disagreement, the final decision was reached with participation of a third investigator.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e A total of 17 articles were included in this review. 5 reports on the influencing factors of death readiness were presented. The investigated influencing factors covered sociodemographic factors, individual factors, and environmental factors. It involves 5 death readiness assessment scales, primarily evaluating psychological aspects, quality of life, and attitude towards death. 1 paper on the development of the model of death preparation. 10 studies reported interventions for death preparedness, primarily including Meaning-centered positive psychological intervention, palliative care, reminiscence therapy, and death education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Based on the scope review method, this study sorted out the main influencing factors of death readiness of dying patients, and proposed that the existing intervention measures should be improved in combination with these factors, so as to improve the level of death readiness of dying patients. In the future, it is necessary to develop multi-dimensional assessment tools adapted to local culture to support the formulation of individualized intervention strategies, so as to improve the death readiness of dying patients as a whole and promote their good death.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact:\u003c/strong\u003e This review clarifies the key gaps in the study of death readiness of dying patients, and provides a theoretical basis and practical direction for the development of targeted assessment tools and personalized intervention strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReport format: \u003c/strong\u003eFollow the PRISMA Extension (PrisMA-SCR) guidelines for scope definition review, and use a literature screening flowchart to present the search and inclusion process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient or public contribution: \u003c/strong\u003eNo.\u003c/p\u003e","manuscriptTitle":"Type of contribution:Scoping Review Death Readiness among Terminally Ill Patients: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 16:46:50","doi":"10.21203/rs.3.rs-8211775/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-06T14:08:38+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-12T06:16:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-03T09:59:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-03T02:45:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2025-12-03T02:39:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f348ab3f-292f-41e2-a892-390bbf17455c","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-11T16:46:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 16:46:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8211775","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8211775","identity":"rs-8211775","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}