Impact of death education programs on nurses’ and nursing students’ mortality perceptions and end-of-life coping competencies: a decade-long systematic review and meta-analysis

Objectives To evaluate the effects of death education on nurses’ and nursing students’ attitudes toward death and end-of-life care competence. Design Systematic review and meta-analysis of RCTs and CCTs. Data sources Seven databases (2014–2025) including PubMed, Embase, CNKI, etc. Review methods Two reviewers independently screened, extracted data, assessed risk of bias (RoB 2.0), and rated evidence certainty (GRADE). Random-effects meta-analyses, subgroup, and sensitivity analyses were performed. Results Thirteen studies ( N = 1,142) were included. Death education significantly improved end-of-life care competence (SMD = 1.05, 95% CI: 0.76–1.34, p < 0.001, I 2 = 54%, moderate certainty). However, no significant effect was found on attitudes toward death (SMD = 0.25, 95% CI: −0.17 to 0.66, p = 0.24, I 2 = 83%, very low certainty). Subgroup analyses showed consistent benefits for online and in-person training. Sensitivity analyses confirmed robustness. Most studies had high risk of bias, and only 3/13 included follow-up. Conclusion Death education may enhance end-of-life care skills, but its impact on death attitudes is uncertain. Evidence is limited by high risk of bias, heterogeneity, and lack of long-term follow-up. Future rigorous RCTs with longer follow-up are required. Findings should be considered hypothesis-generating.