Hospice providers that integrate a deep focus on emotional well-being in their staff training efforts could see improved workforce and patient satisfaction.

Hospice and palliative care workers often lack training around the complexities of death anxiety and the various emotional and physical tolls it can take on an individual, according to Dr. Keri Brenner, psychiatrist, palliative care physician and clinical associate professor at Stanford University.

The lack of training has hindered hospice employees’ ability to navigate the various challenges of coping with death on a daily basis, which can in turn impact staff’s capacity to provide patient support, Brenner said during the Annual Assembly of Hospice & Palliative Care, an event by the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA).

“Despite the prevalence and profound impact, this existential death anxiety is often unexplored or under-explore in [hospice] and palliative care training, which leaves a gap in the skills and therapeutic support that we’re able to provide for patients,” Brenner said during the assembly. “Death anxiety is a universal aspect of the human experience that profoundly affects both our patients and ourselves. Our ability to accompany patients in their existential struggles is directly tied to our willingness to confront our own mortality.”

Death anxiety can manifest in various ways depending on a person’s lived experiences, according to Dr. Danielle Chammas, psychiatrist and palliative care physician at University of California San Francisco (UCSF) Health.

Training programs need to educate hospice staff on how to identify the diverse signs of potential existential distress that could be internally occurring within themselves and externally among patients and their families, Chammas stated. With greater recognition can come a stronger ability for staff to help break down common barriers to wider emotional support, she said.

This kind of training could lead to better goals-of-care conversations that allow for more honest and open discussions with patients, according to Chammas. Additionally, it could help staff recognize when they might be reaching a need for more emotional support, she indicated.

Expanded death anxiety training can also aid in hospices’ ability to deliver culturally and spiritually inclusive care, Chammas added.

“As clinicians, our behaviors and our attitudes can either alleviate or exacerbate death anxiety in the patients and families we’re seeing,” Chammas said during the assembly. “We might not be tapped into the things that we’re doing that are having a really big impact. Our potential can go in both directions [of] self-reflection in order to help alleviate the collective death anxiety [and] in order to best foster a culturally sensitive environment that normalizes mortality and makes space for diverse experiences and beliefs. We have to do the work of examining our own assumptions about death, our biases, our emotional responses.”

Key components of death anxiety training include an emphasis on reflective and mindfulness practices, development of distress tolerance and personal therapeutic services, according to Brenner. Teaching hospice clinical workforces how to lean into the discomfort of existential distress can help ease anxiety and tension among providers and patients, she added.

Hospices that are intentional about offering death distress education opportunities may see stronger staff engagement, Brenner indicated. Having this anxiety training component could help hospice leaders to be more dialed into their clinical workforce’s emotional and mental health needs. The ability to navigate existential death anxiety can become a significant asset and strength for hospice staff, she stated.

“Death anxiety … is not merely an individual experience, but can also be a shared existential struggle that can permeate our clinical interactions,” Brenner said. “[It’s] often even unspoken, but we know it’s ever present. Those practices of building up self-awareness and our ability to manage these tendencies constructively really matter.”