Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.112238
Revised: September 26, 2025
Accepted: November 18, 2025
Published online: January 27, 2026
Processing time: 155 Days and 1.9 Hours
Patients with advanced esophageal cancer and their families often experience reduced quality of life (QoL) and heightened negative emotions. Death education may offer benefits, but evidence in this context is limited.
To investigate the impact of a systematic “four-step death education” intervention on the QoL and negative emotions of postoperative patients with advanced eso
A retrospective cohort study was conducted involving 235 patients with advanced esophageal cancer who underwent surgery at The Fourth Hospital of Hebei Medical University from June 2021 to June 2024. The participants were assigned to either the standard care group (SCG, n = 127) or the “four-step death education” group (FDEG, n = 108) on the basis of the received intervention. SCG received standard care and basic psychological support, and FDEG additionally received a four-stage death education program encompassing information provision, emotional support, life review and meaning exploration, and end-of-life care preparation. QoL and negative emotion levels were measured using validated instruments: The European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 for patient QoL, the Family QoL Survey, the Zarit Burden Interview for caregiver burden, the Pittsburgh Sleep Quality Index, the Self-Rating Anxiety Scale, the Self-Rating Depression Scale, and the Attitudes Toward Life and Death Scale. Assessments were conducted at baseline and 3 months post-intervention.
Baseline characteristics were comparable between groups. At 3 months, FDEG demonstrated significantly improved symptom and functional domain QoL scores in several areas, including fatigue, nausea, insomnia, loss of appetite, and physical and emotional functioning. FDEG reported increased family QoL and reduced caregiver burden. The patients and caregivers in FDEG showed superior improvements in sleep quality and greater reductions in anxiety and depression scores than those in SCG. Post-intervention, FDEG exhibited more positive attitudes toward death.
The postoperative “four-step death education” intervention enhances QoL, relieves caregiver burden, and reduces negative emotions among patients with advanced esophageal cancer and their caregivers, supporting broadened implementation of structured death education programs in palliative care settings.
Core Tip: This study evaluated the impact of “four-step death education” intervention on the quality of life and negative emotions of postoperative patients with advanced esophageal cancer and their caregivers. The intervention, which included information provision, emotional support, life review, meaning exploration, and end-of-life care preparation, showed improvements in quality of life, reduced caregiver burden, and alleviated anxiety and depression. Key mechanisms involved knowledge empowerment, emotional release, meaning creation, and collaborative end-of-life planning. These findings suggest that incorporating such death education into standard palliative care may enhance the overall well-being of patients and families facing terminal illness, though further research is needed.