SAP Nursing Depths Series
SAP Nursing Depths Series
Review Article 2025 Vol. 4 nds2025152

Nursing attitudes in end-of-life care described by the FATCOD scale: a review of the literature

Angy L Camargo Angel1 , Daniel J Duran González1 , Lizeth N Vásquez Rondón1 , Marlyn S Galvis Caro1 , María A Pulido Montes1 , Luz M Contreras Ramos1
1Universidad Cooperativa de Colombia, Facultad de Enfermería. Bucaramanga, Colombia.

https://doi.org/10.56294/nds2025152

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Abstract

Introduction: Attitudes "allows behavioral tendencies to be mobilized through cognitive, emotional and rational components" (Espinoza et al., 2016), being necessary within the development of nursing skills in palliative care, to know the attitudes towards the care of terminally ill people and of their families; worldwide there are several scales, one of them, the Frommelt Attitude Toward Care of the Dying (FADCO) scale, which measures nursing attitudes towards the care of dying patients and their families, which has been validated and used in different countries and languages. Objective: This study aims to identify nursing attitudes in end-of-life care described by the FATCOD scale. Method: A review of the literature was carried out, of scientific articles related to research on the FADCO scale, including articles with full text in Spanish, English and Portuguese, published between 1990 and 2022, including quantitative research, case and control studies, clinical trials, cohort studies and cross-sectional studies; A search was carried out in different databases such as virtual health library, OVID Medicine and Nursing, Proquest Family Health Database, Proquest Health & Medical Collection, Proquest Nursing & Allied Health Database, Proquest Public Health Database, among others. Results: The search for articles was carried out by means of 26 combinations of keywords to give search formulas, the total sample consisted of 40 articles included in the narrative review, finding that 20 % of the countries where the scale was most used was Turkey and China, another important aspect that was evidenced is that according to the culture and beliefs the instrument presented diversity of dimensions and linguistic adaptation according to the country; Regarding the population that was applied, it is distributed among nursing students and professionals with an average age of 36 years, 92 % were women, 95,5 % of the nurses practice some religion while 87,5 % of the students do not report or do not practice. A religion. The respondents have from 1 to 6 years of experience, the students report that only 9,1 % have had contact with death, compared to what was found in the professionals that 65 % of these had training and contact with death experiences, in In relation to the scale score for professionals it was 88 points and for students 84 points, which indicates that the attitudes of this group are in a medium range and can be an alert for the academy to strengthen skills in palliative care. necessary for the care of the patient and his family. Conclusion: It is important to highlight that there are scales or measurement instruments to know the state of preparation and level of competencies that are available to provide quality care. In this narrative review, it was documented that the FATCOD scale has been used in multiple countries with this purpose, highlighting that attitudes modify behavior trends according to their thinking and react in a context protecting their values and beliefs, which translates into attitudes that the professional has to handle a critical situation as it is in different contexts according to their professional profile.

Keywords

attitude, palliative care, end-of-life care, knowledge, FATCOD scale

INTRODUCTION

End-of-life care has gained significant relevance in the context of current health systems,(1,2,3,4,5) due to the progressive aging of the population and the increase in chronic noncommunicable diseases.(6,7,8,9,10) In this scenario, palliative care is recognized as a growing need that necessitates the intervention of trained professionals, particularly nurses,(11,12,13,14,15) whose work is crucial in supporting the dying patient and their family.(16,17,18,19,20) The quality of care offered at this vital stage depends not only on technical knowledge but also on the professional's attitudes,(21,22,23) communication skills, and ethical sensitivity.(24,25,26,27)

Several studies have pointed out that the attitudes of health care personnel towards death directly influence the care provided.(28,29,30,31,32) These attitudes are determined by factors such as academic training,(33,34,35,36) previous experiences, religious beliefs, sociocultural environment, and previous contact with death.(37,38,39,40,41) Therefore, it is necessary to explore and understand how these variables affect the behavior of professionals in critical end-of-life situations,(42,43,44,45,46) to strengthen their preparation during training.(47,48,49,50)

In response to this need, measurement instruments have been developed, such as the Frommelt Attitude Toward Care of the Dying Scale (FATCOD),(51,52,53,54,55) which has been widely used internationally to evaluate the attitudes of nursing students and professionals toward the care of terminally ill patients.(56,57,58,59,60) This tool enables the identification of areas for improvement in attitudinal competencies,(61,62,63,64,65) contributing to the design of more effective educational strategies.(66,67,68,69,70,71,72,73)

The purpose of this research was to conduct a review of the scientific literature available in institutional and open databases, aiming to identify the attitudes of nursing personnel towards palliative care, as well as the associated sociodemographic factors and the applicability of the FATCOD scale in various contexts. This work seeks to contribute to the strengthening of palliative care training, promoting the humanization of care, dignity in the dying process, and the development of competencies that guarantee comprehensive and empathetic care at the end of life.

What are the attitudes of nursing staff towards end-of-life care, and what factors influence them according to the scientific literature?

Objective

To analyze, through a review of the scientific literature, the attitudes of nursing staff towards end-of-life care, identifying the factors that condition them, and evaluating the applicability of the FATCOD scale in different contexts.

METHODS

Design

A literature review was conducted, which involved consulting and extracting information from scientific articles available on the Universidad Cooperativa de Colombia platform regarding the attitudes of healthcare personnel towards palliative care.

Population

The present research was conducted using scientific articles from the databases of the Universidad Cooperativa de Colombia and open-access databases, specifically those related to the Frommelt Attitude Toward Care of the Dying Scale (FATCOD).

Sample

The scientific articles that met the inclusion and exclusion criteria were included in the present study.

Variables

For this research, variables describing age, sex, working time in nursing, number of patients cared for, years of experience in palliative care, hours spent in palliative care, dimensions such as fear/discomfort, family care, communication, family as caregiver, relationship, active caregiving were taken into account (table 1).

Table 1. Variables

Name

Definition

Nature

Level of measurement

Age

Life span from birth

Quantitative - discrete

Ratio

Sex

Characteristics that define a human being human being

Qualitative - dichotomous

Nominal

Time working in nursing

Time in which you have worked as a nurse as a nurse

Quantitative - discrete

Ratio

Number of patients seen

Patients seen during your working life working life

Quantitative - discrete

Ratio

Years of experience in palliative care

Time spent in the palliative care field palliative care

Quantitative - discrete

Ratio

Hours spent in palliative care

Number of hours spent providing palliative care

Quantitative - discrete

Rationale

Fear/discomfort

Feeling that something is going to happen, either real or imagined real or imagined.

Quantitative - discrete

Reason

Family caregiver

Those people in the family who are responsible for assisting in the activities of daily living for people who are ill or dependent.

Quantitative - discrete

Rationale

Communication

The delivery of information from one person to another, which can be verbal and non-verbal.

Quantitative - discrete

Reason

Family as care

The family group is defined as a unit that provides care support during the course of the disease.

Quantitative - discrete

Ratio

[empty cell]

They are connections between two or more people, which intervenes in the process of health-illness, where it implies a therapeutic communication between the subject of care, family and nursing staff, it is indispensable in the process as it gives response to the suffering suffered by the sick person.

Quantitative - discrete

Nominal

Relationship

[empty cell]

[empty cell]

[empty cell]

Active care

Holistic care for people who are ill. holistic assistance to people who are ill.

Quantitative - discrete

Ratio

In order to carry out the search and selection process of the keywords for the present study, the following words were obtained from the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) page (figure 1- Annex).

Combination with Booleans

For the present research, the Boolean connectors AND and OR were used to construct the formulas used for the search (Figure 2 – Annex).

Sources of information

Institutional databases: the university's databases were consulted, such as the virtual health library, OVID Medicine and Nursing, Proquest Family Health Database, Proquest Healt & Medical Collection, Proquest Nursing & Allied Health Database, Proquest Public Health Database, Health Journals and Books Visibility, Proquest Education Database, Proquest India Database, Proquest Latin America & Iberia Database, Proquest Middle East & Africa Database, Proquest Psychology Database, Proquest Research Library, Proquest Science Database, Proquest Social Science Database, Proquest UK & Ireland Database, Redalyc, Dialnet, Oxford, Proquest Central, Sage Journals, Science Direct, Springer journal, Taylor & Francis, Scopus.

Open databases: once the search in the university databases was completed and the necessary saturation of articles was not achieved, a search of open databases, such as Google Scholar, Scielo, and PubMed, was carried out.

Selection

First, the variables and descriptors previously identified as referents for the search were taken into account as inclusion and exclusion criteria.

Inclusion criteria

Language: articles were included whose full text was in Spanish, English, and Portuguese.

Time range: articles were included from 1990 to the present, since the application of this scale has been reported since that time.

Type of publication: quantitative articles, such as case-control studies, clinical trials, cohort studies, and cross-sectional studies, were included in the search.

Exclusion criteria

Open Access articles were excluded.

Inclusion

After applying inclusion and exclusion criteria, a search was made in the databases described above, after which the articles were exported to the bibliographic reference manager "Mendeley" to eliminate possible identical articles among the results, with this process articles were selected that were reviewed in full for their inclusion in this study and subsequent analysis.

Analysis of the information

Using the previously selected articles, a complete reading of the text was performed, extracting the necessary information that was stored in a database created by the researchers which contained the following items: name of the article, journal in which it was published, author or authors, date of publication, country, field of performance, general objective and specific objectives, study design, population, sample, methodology, instruments used, to describe the attitudes and knowledge of nurses in critical services.

Ethical Aspects

According to regulation 008430 of 1993, article 11, this research is classified as "no risk" research because "no type of intervention will be carried out, it will be a review of the literature" (Ministry of Health, 1993).

RESULTS

For this narrative review the search for articles was carried out using 26 combinations of key words to give search formulas described above, the articles investigated on the subject matter in this narrative review were found distributed in each database as follows: Redalyc with 0,77 % (5392), Dialnet with 6 % (43), Google academic with 0,20 % (1474), Proquest Central 73 % (516), Pubmed Central 13 % (93), other databases 11 % (83 420), yielding a total of 703 011 articles (100 %), of which were included and excluded according to the criteria set out in the methodology of this literature review, resulting in a total of 40 articles corresponding to 100 % of which finally for the databases were found with: Redalyc with 12,5 % (5), Dialnet with 7,5 % (3), Google academic 22,5 % (9), Proquest Central 35 % (14), Pubmed Central 15 % (6), other databases.

Figure 3. Flowchart of data databases 7,5 % (3), as shown in the flowchart

Of the 40 articles reviewed, the highest prevalence was found between 2019 and 2022, with 10 % (4) corresponding to 2019, 17,5 % (7) corresponding to 2020, 17,5 % (7) to 2021, and 12,5 % (5) to 2022. (7) 2021 and 12,5 % (5) for the year (2022). According to the countries with the highest publication of articles, the top three were: Turkey (10 %, 4), China (10 %, 4), followed by Italy (7,5 %, 3) and Spain. 7,5 % (3), Sweden 5 % (2), South Korea 5 % (2), United States 5 % (2), Japan 5 % (2), Australia 5 % (2); and ending with those countries with the lowest number of publications, among them Iran, Greece, Egypt, Switzerland, Nigeria, Vietnam, Mongolia, Indonesia, Poland, Chile, United Kingdom, Israel, Africa, India with 55 % (1). On the other hand, 100 % (40) of the articles reviewed in the following table are the most outstanding findings.

Description of findings

Table 2. Results of sociodemographic variables and FATCOD scale in students

Table 1.

Findings

Reference

Students' ages ranged from 17 to 49 years old.

(2,3,4,5,6,7,8,9,10,11,12,13,14,15)

In terms of gender, females predominate in a range between 73,2 % and 92,9 %.

(2,3,4,5,6,7,8,9,10,11,12,16,13,14,15)

Only four articles asked about religion and in three of them the Catholic religion predominates with a range between 61 % and 81 %.

(2,5,6,14)

Only three articles asked whether they received pre-death education with a range between 39,46 % and 74 %.

(2,6,9)

A FATCOD scale score was found to be between 74,69 and 132 points.

(2,3,4,5,6,7,8,9,10,11,12,13,14,15,16)

According to the literature review, this scale has been applied to professional nurses and nursing students; for students, the results were as follows: the average age was 33 years, and the sex of the participants was predominantly female, with 83. As for religion, 71 % of them were Catholics, 57 % of them had had training in palliative care, and their attitudes were favorable, with a score of 103 on the scale in the care of the patient and family in a palliative situation, see table 2.

Table 3. Results of sociodemographic variables and FATCOD scale in professionals

Table 2.

Findings

References

Within the review it was found that ages ranged from 16 to 67 years.

(17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37)

In terms of gender, females predominate with a range of 56,3 % and 98,6 %.

(17,19,20,21,22,23,24,25,26,27,28,29,30,31,33,34,35,36)

Only six articles asked about religion and in 2 articles it mentions that Buddhism was professed with 56,9 % and Jewish with 89 % (Braun et al., 2010).

(21,24,26,29,32)

The remaining only mentioned that they professed a religion, but did not specify which one religion, but did not specify which one.

[empty cell]

In 8 items the marital status was asked, where 7 items responded that they were married, ranging from 51,8 % to 78,7 %.

(19,21,25,26,29,31,32,37)

It was found that 10 articles questioned work experience, of which 6 articles were nursing graduates with a range of 45,4 % and 85,4 %; in 4 articles it mentions that they they were pursuing a postgraduate degree.

(24,25,29,31,32,33,35,36)

A score was found to be between 51,173 and 125,7 points.

(17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37)

As for the professionals, it was found that the average age of 41,5, 77 % of the interviewees were female, 15 % of the reviewed articles ask about religion and 5 % of the articles mentioned professing Buddhism with and Jewish, the remaining 95 % only mentioned professing a religion, but did not specify which one, 20 % of the articles in the narrative review questioned the population studied on marital status, 65 % being married, 65 % of the professionals selected for the studies had experience in the area of palliative care for them the scale was favorable with a mean of 88, this being attributed to administrative and legal functions and work overload.

Table 4. Results of sociodemographic variables and FATCOD scale in professionals and students

Table 3.

Findings

References

The ages of the students and professionals ranged from 23 to 49 years old.

(38,39,40,41)

In terms of sex, females predominate in a range of 87 % to 98 %.

(38,39,40,41)

Only one article asked the practice of any religion 95,5 % of the nurses practice a religion and 87,5 % of the students do not practice a religion.

(38)

Only one article asked the degree of study 53,9 % of the nursing students

were pursuing a graduate degree.

(38)

Respondents had from 1 to 16 years of work experience.

(38,40,41)

Only in one article if they had education prior to death between 9,1 % and 60,4 %.

(38)

It was found a score between 29,96 and 139,20 points.

(38,39,40,41)

In the studies that included students and professionals, the mean age of the population studied was 36 years. The sample consisted of 92 % women. Nurses practiced some form of religion, with 95,5 % of the nurses identifying as practicing a religion. In contrast, 87,5 % of the students did not report or practice a religion. The respondents have 1 to 6 years of experience. If they have had contact with death 9,1 % of the students, and 60,4 % of the professionals when comparing the score of these two groups it is evident that it found a score of 84 which indicates that the attitudes of this group are in a medium range and can be an alert for the academy to strengthen competencies in palliative care necessary for the care of the patient and his family.

CONCLUSIONS

In this narrative review it was documented that the FATCOD scale has been used in multiple countries for this purpose, highlighting that attitudes modify behavioral tendencies according to their thinking and react in a context protecting their values and beliefs, which is translated into attitudes that the professional has to handle a critical situation as it is in different contexts according to their professional profile.

For the nursing discipline, the specific competencies that professionals need in their daily practice are essential. According to the narrative review carried out, it was concluded that the services where the FATCOD scale has been most applied are the palliative care and intensive care unit areas.

Based on geographical location, the continent where the FATCOD scale has been applied and used most is Asia, followed by Europe, making it essential to apply it in the rest of the world.

RECOMMENDATIONS

For future research, the FATCOD scale measurement should be considered for the training needs of nursing students and professionals regarding end-of-life care competencies, to identify potential training gaps.

Likewise, it is recommended that future research using the FATCOD scale considers conducting analyses associated with the usefulness of the educational content provided on end-of-life care during the student stage, with the aim of the consolidation of this knowledge from the academy.

It is necessary to validate the FATCOD scale in Colombia to develop contextualized research evaluating attitudes towards end-of-life care. This will provide reliable theoretical support for designing educational strategies that promote curriculum improvement for both nurse-in-training and professional nurses.

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Declarations

Funding

None.

Conflict of interest

The authors declare that there is no conflict of interest. AUTHORSHIP CONTRIBUTION Conceptualization: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Data curation: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Formal analysis: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Research: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Methodology: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Project Management: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Resources: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Software: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Supervision: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Validation: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Visualization: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Writing - original draft: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. Writing - proofreading and editing: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos. ANNEX Figure 1. DeCS and MeSH Descriptors Figure 2. Combination with Booleans

Authorship contributions

Drafting – original draft: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos.

Writing–review and editing: Angy L Camargo Angel, Daniel J Duran González, Lizeth N Vásquez Rondón, Marlyn S Galvis Caro, María A Pulido Montes, Luz M Contreras Ramos.

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