Effectiveness of a multiphase experiential death education program on death anxiety in primary care professionals: A randomized delayed-start controlled trial

AIM: To evaluate the effectiveness and sustainability of a multiphase experiential death education program, grounded in Kolb's Experiential Learning Theory, in reducing death anxiety among primary care professionals (PCPs). BACKGROUND: High exposure to patient death contributes to significant death anxiety among PCPs, which is linked to burnout, clinical avoidance. Traditional didactic death education has limited efficacy. DESIGN: A randomized delayed-start controlled trial. METHODS: Fifty-five PCPs from a Shanghai community health alliance were randomized to an Immediate Group (IG, n = 27) receiving an 8-week core program plus quarterly boosters, or a Delayed Group (DG, n = 28) starting the intervention after a 3-month waitlist. Death anxiety was measured using the Templer Death Anxiety Scale (T-DAS) at baseline (T0), immediately post-core (T1), 3-month sustainability point pre-booster (T3) and 12-month endpoint (T12). Data were analyzed using linear mixed models and ANCOVA. RESULTS: Significant between-group differences favoring the IG were observed at T1 (adjusted mean difference = -1.81, 95% CI: -2.92 to -0.71; Cohen's d = 0.83, p = .002). The effect enlarged by T3 (adjusted difference = -1.91, 95% CI: -2.75 to -1.06; d = 1.22, p < .001), demonstrating enhancement of core program effects prior to booster delivery. Group × time interaction was significant (p = .006), confirming divergent trajectories. Between-group differences remained significant at T12 (p < .001). CONCLUSIONS: This theory-driven, experiential program produces robust, sustained and self-augmenting reductions in death anxiety. It demonstrates considerable promise as a replicable training model for enhancing psychological resilience and end-of-life care capacity in primary care settings.