Death anxiety and religious orientation among patients receiving palliative care in Turkey: a multicenter cross-sectional study

Abstract

Death anxiety is a clinically relevant psychosocial concern in palliative care, and religious orientation may influence how patients interpret and cope with end-of-life experiences. This study aimed to examine the relationship between death anxiety and general religious orientation in patients receiving palliative care and to assess whether sociodemographic and health-related factors were associated with these outcomes. This multicenter cross-sectional study was conducted between November 2023 and April 2024 in three palliative care units in Istanbul, Turkey. Data were collected through face-to-face interviews with 201 hospitalized palliative care patients using a Descriptive Information Form, the Death Anxiety Scale (DAS), and the Religious Orientation Scale (ROS). Pearson correlation, independent-samples t-test, one-way ANOVA with Bonferroni post-hoc tests, and multivariable linear regression analyses were used. A total of 201 patients were included, with a mean age of 69.47 ± 11.68 years. The mean DAS score was 6.23 ± 3.98, with 54.7% reporting low and 45.3% high death anxiety. The mean ROS score was 32.92 ± 13.68 within a possible score range of 18–72. The association between ROS and DAS was not significant in the unadjusted analysis and remained non-significant after adjustment for sociodemographic and health-related covariates (B = − 0.02, 95% CI: −0.07 to 0.03, p = 0.478). However, DAS and/or ROS scores differed significantly according to selected sociodemographic and health-related characteristics, including age group, gender, education level, income level, and previous hospitalization history. In adjusted analyses, higher DAS scores were associated with female gender, education above illiteracy, high income, and previous hospitalization history, while ROS scores were mainly associated with education level and previous hospitalization history. Death anxiety showed substantial variability, with nearly half of the patients reporting high death anxiety. No significant association was observed between death anxiety and general religious orientation, suggesting that religious orientation, as measured in this study, should not be considered a proxy for broader spiritual, existential, or psychosocial needs. Adjusted analyses showed distinct patterns for the two outcomes. These findings highlight the multidimensional nature of psychosocial and spiritual responses in palliative care and support the need for comprehensive assessment of death anxiety and spiritual needs.