Death Anxiety,Religious Attitude and Associated Factors in Dialysis Patients,A Descriptive Study;Turkey Sample

Abstract

Aim: The aim of this study is to determine the relationship between death anxiety and religious attitudes of patients receiving hemodialysis and peritoneal dialysis treatment, and to determine the differences between the two treatment groups according to the affecting factors. Method: It is a descriptive research. The study was completed with 105 individuals receiving dialysis treatment. The study universe is dialysis patients who continue their treatment in the same hospital. The sample size and power was determined by utilizing the results of another study. Descriptive characteristics form, Religious Attitude Scale and Death Anxiety Scale were used to collect data. Results: The mean age, religious attitude scale score and death anxiety scale score of the participants is 57,01 ± 12,969, 3,10 ± 0.612, and 9,55 ± 3,533, respectively. Conclusion: The religious attitude of dialysis patients is moderate and they have death anxiety. Hemodialysis patients have more death anxiety. There is a weak correlation between religious attitude and death anxiety. Recommendations: It can be suggested that nurses who care for dialysis patients, should be aware of the role of religion in the lives of dialysis patients and its relationship with health outcomes, and it may be recommended to apply holistic care for these patients to express their feelings and their concerns about death.

Keywords

dialysis death anxiety religious attitude nursing

Introduction

Chronic renal (kidney) failure (CKD) is an important chronic disease that physically, psychologically, mentally and socially affects the individual. Its prevalence worldwide is 13.4% (11.7–15.1%). Hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation are applied for the treatment of CKD. The rates of HD, PD and kidney transplantation treatments are 76.1%, 4.7%, and 19.2%, respectively (Seyhani et al., 2018). Whatever treatment is applied, patients experience anxiety, stress (Durmuş & Ekinci, 2021), spiritual problems (Angın, 2021), deterioration in quality of life (L.Kimmel et al., 2021) starting from the first stage of their disease. It is stated that the anxiety experienced is actually death anxiety (Ghiasi et al., 2021; Hashemi et al., 2021; Hosseini et al., 2022; Khodarahimi et al., 2021; L. Kimmel et al., 2021). Both HD and PD patients experience this anxiety, and the dose of anxiety increases as the disease progresses (Nia et al., 2017).

Death has been a part of humanity since ancient times. With the meaning of death, “death anxiety” has also begun to be interpreted. Death anxiety is a feeling of worry or fear that is typically triggered by the thought of death. Death anxiety is wide-ranging. It can include death and separation from loved ones, suffering, being alone, worrying about being buried, spiritual concerns, etc. (Pollak, 1980; Templer, 1970). It is seen that death anxiety is very common in individuals with chronic diseases and this has a psychological origin (Bibi & Khalid, 2020). Death anxiety is among the psychological problems experienced by individuals with CKD, and it is argued that this should be reduced. To ensure this; applications such as psychotherapies (Khodarahimi et al., 2021; Saki et al., 2021), directing the patient to perceive the disease more positively (Soleimani et al., 2018), providing social support (Bibi & Khalid, 2020), strengthening of spirituality (Asadzandi, 2020; Durmuş & Ekinci, 2021; Hosseini et al., 2022), increasing psychological resilience through religious coping (Angın, 2021), praying (Gholami et al., 2020) are recommended. It is stated that anxiety can be reduced with moral support (Chen et al., 2021).

Spirituality is defined as “one’s experience of connecting with the essence of life, seeking connection with oneself, others, nature and divinity” (Steinhauser et al., 2017). The spiritual background of the individual (Asadzandi, 2020; Durmuş & Ekinci, 2021; Gholami et al., 2020; Hosseini et al., 2022), or religious perspective (Angın, 2021; Sağlam Demirkan, 2020) are the features that affect death anxiety and increase coping power. For this reason, it is recommended to strengthen the spirituality of individuals who experience death anxiety (Angın, 2021; Asadzandi, 2020; Durmuş & Ekinci, 2021; Gholami et al., 2020; Hosseini et al., 2022; Sağlam Demirkan, 2020). It is known that spirituality affects death anxiety in Muslim societies (Saleem & Saleem, 2020).

It is seen in the literature that; religious perspective ((Angın, 2021; Sağlam Demirkan, 2020), spiritual well-being (Asadzandi, 2020; Durmuş & Ekinci, 2021; Gholami et al., 2020; Hosseini et al., 2022), death anxiety (Asadzandi, 2020; Ghiasi et al., 2021; Hosseini et al., 2022; Nia et al., 2017; Saki et al., 2021; Soleimani et al., 2018) are studied in different groups of patients with chronic renal failure. In the study of Sağlam Demirkan (2020), it is recommended to investigate death anxiety and religious attitudes in patients with chronic renal failure (Sağlam Demirkan, 2020). The aim of this study was to determine the correlation between death anxiety and religious attitudes of patients receiving hemodialysis and peritoneal dialysis, and the factors that affect the death anxiety.

Method

It is a descriptive and correlational research.

Research questions: In hemodialysis and peritoneal dialysis patients; (1) What is the religious attitude status/level? (2) What is the level of death anxiety? (3) What are the factors affecting death anxiety? (4) Is there a relationship between religious attitude and death anxiety?

Universe and Study sample

The universe of the study consisted of patients followed by the Nephrology Clinic of XXX University Medical Faculty Hospital and receiving hemodialysis and peritoneal dialysis treatment in the same hospital.

Study sample

The data of a similar study was used in the study. In the aforementioned study, the death anxiety score of the spiritual care group and non-spiritual care group was 18.53 ± 10.49 and 31.28 ± 12.56 (p < 0.001) (Hosseini et al., 2022). According to these results, the sample size was calculated according to the difference between the scores of the two independent groups in the G*Power 3.1.9.4 package program. Since p < 0.001 was reported in the source article, the margin of error was taken as 0.001 in the calculation. According to this calculation; it was determined that the sample size should be at least 84 people, with a margin of error of 0.001 and a power of 0.99. Sample size was increased according to literature (Yıldırım Kaptanoğlu, 2013) and the study was completed with 105 individuals. The study includes: patients who are >18 years old, who continue to receive HD or PD treatments, who belong to the religion of Islam, who do not have a communication barrier, who are not in the process of cancer treatment. Being in the terminal period and having cognitive problems are exclusion criteria.

Data Collection Forms and Data Collection

Descriptive Characteristics Form, Religious Attitude Scale and Death Anxiety Scale were used to collect data.

Descriptive Characteristics Form

The characteristics features form was created by the researchers based on the literature (Durmuş & Ekinci, 2021; Gholami et al., 2020; Hosseini et al., 2022; Khodarahimi et al., 2021; L. Kimmel et al., 2021), and it consisted of twelve questions in total. Headings that make up the questions can be added (sociodemographic and disease characteristics, etc.)

The Ok-Religious Attitude Scale

The scale was developed by Ok (2011) in order to assess religious attitudes for Muslim groups. There are four sub-dimensions (cognitive, emotional, behavioral, relational) in the eight-item scale. It is a five-point Likert scale. The items are coded as follows: strongly disagree (agree not at all) (1), slightly (a little) agree (2), fifty-fifty (half the time) agree (3), mostly (mainly) agree (4), completely agree (5). The first and second items are reverse scored. The scale is evaluated over the total score as follows; 1.00–1.49 = little or no religion at all, 1.50–2.49 = a little religious, 2.50–3.49 = moderately religious, 3.50–4.49 = highly religious, 4,50–5.00 = devoutly religious/strong believer. Although the Cronbach Alpha internal consistency reliability coefficient varies in the sub-dimensions (0.90–0.75), it is 0.90 for the whole scale (Ok, 2011; 2016). In this study, the Cronbach Alpha coefficient was 0.828.

Death Anxiety Scale

The scale was developed by Templer et al. (1970) to measure death anxiety (Templer, 1970). Re-examination of the scale, whose validity and reliability studies were carried out before, was performed by Akça and Köse (2008). The scale is a binary Likert type scale consisting of 15 items and answered as true or false. One point is given for the “correct” answers to 1, 4, 8, 9,10,11,12,13,14 questions and the “false” answer to the other questions. The highest score that can be obtained from the scale is 15. As the score obtained from the scale increases, the level of death anxiety increases. A total score of 8 and above indicates the presence of death anxiety in the individual. The Kuder Richardson-20 reliability coefficient of the Turkish scale is 0.75 (Akça & Köse, 2008). The Cronbach Alpha coefficient was 0.829 in this study.

Data collection

Data were collected face-to-face by the researchers during the periods when patients were in PD and HD units. During data collection, protective measures were taken for the risk of infection transmission. An explanation was given to the patients and their verbal/written consent was obtained.

Variables of the Study

Dependent variable

Death anxiety score

Independent variables

Religious attitude score, age, gender, type of dialysis treatment, duration of dialysis treatment, presence of other comorbidities, marital status, income level, education level, employment status.

Ethical Aspect of the Study

Research permission (2022/2195) was obtained from XXX University Health Sciences Scientific Research Ethics Committee, and application permission (E-14567952–900–190074) was obtained from XXX University Medical Faculty Hospital. In all stages of the study, the STROBE (Equador, 2019) checklist and the Declaration of Helsinki were followed.

Statistical Analysis

SPSS 25 (IBM) statistical program was used for statistics. The normality of the distributions was determined according to the Skewness-Kurtosis test result, the −1/+1 range was accepted (George, 2019).

It was shown that age, gender, presence of another disease, education level, duration of dialysis, employment status, income status RAS total, emotion, behavior, god sub-dimension scores, DAS total score is normally distributed, and other variables (type of dialysis, marital status, RAS cognition sub-dimension score) were not normally distributed. Sociodemographic data were analyzed by number, percentage, mean ± standard deviation. Independent Simple T test and One Way Anova were used in the analyzes for normally distributed variables, and Mann Whitney-U and Kruskal Wallis tests were used for non-normally distributed variables. Pearson and Spearman correlation analysis was used to compare the correlation. Correlations were evaluated as follows: r ≤ 0.25 very weak; 0.26 ≤ r ≤ 0.49 weak; 0.50 ≤ r ≤ 0.69 moderate; 0.70 ≤ r ≤ 0.89 strong; 0.90 ≤ r < 1 very strong. Linear Regression Analysis was performed for suitable variables.

Results

The findings of the study examining the religious attitudes and death anxiety of dialysis patients are presented below. The mean, minimum and maximum values of the patients' age and scale scores are given in Table 1. According to these values, it was determined that the patients were moderately religious (=moderately secular). It was determined that they scored the most in the god sub-dimension (very religious) and the least in the cognition sub-dimension (very little religious). It was determined that the death anxiety of the whole group was higher than the cut-off point (Cut-off point: 8) and therefore they were experiencing excessive death anxiety.

Table 1.

Mean Values of Variables.

Variables	Min- Max	Mean	SD
Age	27–82	57.01	12.969
RAS	1–4	3.10	0.612
Cognitive	1–3	1.37	0.609
Emotional	1–5	3.48	1.003
Behavioral	1–5	3.68	0.936
Relational	1–5	3.88	0.919
DAS	2–15	9.55	3.533

Most of the participants in the study were female (51.4%), hemodialysis patients (79.0%), had secondary education (59.0%), retired (48.6%), married (76.2%), had equal income and expenditure (54.3%), had comorbidities (74.1%), and have been on dialysis treatment for 1–3 years (59.0%). DAS scale score is higher in those who continue HD treatment. The difference is statistically significant (p < 0.05) (Table 2).

Table 2.

Distribution of DAS Score According to Independent Variables (n: 105).

Variables		n	%	DAS
Variables		n	%	Mean±SD	Test Statistics
Gender	Male	51	48.6	9.16 ± 3.657	t = 0.577 p:0.267
	Female	54	51.4	9.93 ± 3.403	t = 0.577 p:0.267
Presence of another disease (comorbidities)	Yes	75	74.1	9.81 ± 3.589	t = 1.092p:0.299
	No	30	28.6	8.90 ± 3.356	t = 1.092p:0.299
Dialysis duration	<1 year^a	28	26.7	10.04 ± 3.958	F = 0.424p:0.655
	Between 1–3 year	62	59.0	9.45 ± 3.510
	Between 4–6 years	15	14.3	9.07 ± 2.840
Educational status	Illiterate	3	2.9	10.33 ± 4.726	F = 1.623p:0.189
	Primary education	29	27.6	8.34 ± 3.405
	Secondary education	62	59.0	10.05 ± 3.508
	University and above	11	10.5	9.73 ± 3.438
Working status	Not working	34	32.4	10.03 ± 3.433	F = 1.225p:0.298
	Retired	51	48.6	9.00 ± 3.688
	Paid employee	20	19.0	10.15 ± 3.233
Income status	Income < expenditure	41	39.0	9.73 ± 3.578	F = 0.902p:0.912
	Income = expenditure	57	54.3	9.46 ± 3.566
	Income > expenditure	7	6.7	9.29 ± 3.450
				Mean rank (sum of ranks)
Marital status	Married	80	76.2	53.38 (4270.00)	U = 970.000p:0.821
Marital status	Single	25	23.8	51.80 (1295.00)	U = 970.000p:0.821
Type of dialysis	Hemodialysis	83	79.0	57.23 (4750.59)	U = 561.500p:0.005
	Peritoneal dialysis	22	21.0	37.02 (814.50)	U = 561.500p:0.005

t: Independent Sample t Test. F = One Way Analysis. KW = Kruskal Wallis = Mann Whitney U.

The correlation between scale scores and age was evaluated with the Spearman and Pearson Correlation analysis. When the correlation between the participants' age and scale scores is examined; there is a negative correlation of DAS with age and RAS relational sub-dimension, and there is a weak positive relation with RAS cognitive sub-dimension. There is a negative and weak correlation between DAS and RAS total and two sub-dimensions (emotional and behavioral) (Table 3). As cognition increases, death anxiety increases. As age, RAS total, emotional, behavioral and relational sub-dimension scores increase, death anxiety decreases.

Table 3.

Correlation between DAS and other Scale Scores and Age.

Variables	DAS
Variables	r	p
Age	−0.252^a	0.010 ^d
RAS	−0.216^b	0.027 ^d
Cognitive	0.244^a	0.012 ^c
Emotional	−0.218^b	0.026 ^d
Behavioral	−0.199^b	0.042 ^d
Relational	−0.283^a	0.003 ^d

^aCorrelation is significant at the 0.01 level (2-tailed).

^bCorrelation is significant at the 0.05 level (2-tailed).

^cSpearman Correlation.

^dPearson Correlation.

Linear regression analysis was performed to estimate the determinants of the DAS scale score (Enter method) (Özdamar, 2018). Educational status and dialysis type among the independent variables included in the regression model (p > 0,05). It was determined that only the type of dialysis had a significant effect on the DAS score (p < 0.05). The percentage of an independent variable determining the change in DAS score is R2:0.071. The model explains about 16% of the variation in the scale score. It can be said that continuing the hemodialysis treatment increases the death anxiety by approximately 16% in the 95% confidence interval (Table 4).

Table 4.

The Determinant of Individuals' DAS Score.

Independent Variables	B	Std Error	β	t	p	95,0% Confidence Interval for B		Collinearity Statistics		Condition Index
Independent Variables	B	Std Error	β	t	p	Lower Bound	Upper Bound	Tolerance	VIF	Condition Index
(Constant)	12.345	1.047		11.793	0.000	10.269	14.421
Type of dialysis	−2.241	0.821	−0.259	−2.731	0.007	−3.869	−0.613	1.000	1.000	6.108
R: 0.267 R²:0.071 adjusted R²: 0.062 F: 7.923 p: 006 Durbin Watson: 1.646

Discussion

In this study, it was aimed to determine the relationship between death anxiety and religious attitudes of patients receiving hemodialysis and peritoneal dialysis, and to determine the factors affecting this correlation, and to determine the differences between the two treatment groups. The results were discussed in the light of the literature.

In general, fear of death in patients with kidney failure is observed as “Fear of premature death”, “fear of sudden death” and “fear of dying”. Situations such as worsening of health conditions, having problems with vascular access, dietary restrictions, future anxiety, etc., increase the fear of these patients (Frontini et al., 2021). It has been stated that patients in the dialysis treatment process are emotional and depressed, which triggers their death anxiety (Dönmez et al., 2021). It has been reported that death anxiety is moderate in Muslim individuals (Gholami et al., 2020; Saleem & Saleem, 2020). One of the biggest problems causing death in PD patients is peritonitis. These patients are afraid of peritonitis and therefore dying (Tekkarışmaz & Torun, 2020). It was shown as a result of a study conducted in Jordan that having a deadly disease and the experiences during the disease process are accepted even if death anxiety increases (Othman et al., 2022). In this study, it was found that both HD and PD patients had death anxiety, but HD patients experienced more anxiety. It is possible for hemodialysis patients to continue dialysis 3 days a week, to stay away from their social environment in this process, to re-establish vascular access before each dialysis procedure, to experience pain, to have restrictions on nutrition and fluid intake, to be in the same environment with other patients, and to be adversely affected by poor patients. On the other hand, PD patients do not experience these negativities or experience them to a much lesser extent. This difference may affect death anxiety.

It is known that death anxiety is associated with age, and anxiety increases with age (Dadfar et al., 2018). It has been reported that age is the most important determinant of death anxiety in Iranian elderly adults with chronic diseases, and death anxiety decreases with age (Rezaei Aderyani et al., 2020). On the contrary; it has been reported that death anxiety increases with increasing age in patients who become ill during the COVID-19 process (Kandemir, 2020). Another study states that there is no correlation between age and death anxiety (Tepe, 2020). The fact that adults and individuals with chronic diseases use more drugs is a factor that increases the fear of death (Şanal Karahan & Hamarta, 2019). In this study, it was determined that the participants' fear of death increased with advancing age and increase in cognition. Individuals gain sufficient knowledge about their treatment over time. In this process, the age of individuals is advancing. It can be thought that this situation may support the reduction of death anxiety.

In Muslim societies, the presence of a chronic disease causes the individual to fear the experience of dying, while it is seen that individuals leave the situation to Allah’s discretion/surrender to Allah (Othman et al., 2022). An increase in surrender and spirituality can reduce dialysis patients' problems with psychological origins, such as pain (Nikmanesh & Azaraein, 2017). Emotion-focused coping methods are recommended for individuals to control stress (Kobra et al., 2015). One of the most common coping methods used by dialysis patients is religious coping (Mistik et al., 2016). Religion contributes to the patient’s ability to stay on dialysis longer and thus to the effectiveness of the treatment (Al Zaben et al., 2015). It has been stated that there is a negative correlation between religion and death anxiety (Saleem & Saleem, 2020). A study conducted in Tunisia showed that religious individuals have less death anxiety (Fekih-Romdhane et al., 2020). The outcome of a study of individuals with cancer in Pakistan was similar. Cancer patients who are religious experience less death anxiety (Abbas et al., 2022). Similar studies have shown that patients' religious practices (praying, etc.) increase their quality of life (Burlacu et al., 2019; Harbali & Koc, 2022). Studies carried out in countries with a large number of Muslims such as Philippines (Soriano & Calong, 2022) and Iran (Mina et al., 2018; Rezaei Aderyani et al., 2020), show that being religious affects death anxiety in a positive way. In general, it is explained that religion positively affects the anxiety caused by death, which is the basis of existence (Kandemir, 2020). Similar results were obtained in this study as well. Those who are religious have less death anxiety. Considering that the idea of surrendering to Allah is more intense in religious people among Muslim societies, and this supports the reduction of death anxiety, it can be said that the same condition is true for the Turkish population, which is mostly Muslim.

Conclusion

HD and PD patients have moderate religious attitudes and death anxiety. Death anxiety is higher in HD patients. There is a weak correlation between religious attitude and death anxiety. The most important result of this study is that with the increase in consciousness in dialysis patients, death anxiety decreases and HD treatment increases the fear of death.

Recommendations

It can be suggested that nurses who care for dialysis patients, should be aware of the role of religion in the lives of dialysis patients and its relationship with health outcomes, and it may be recommended to apply holistic care for these patients to express their feelings and their concerns about death. It should not be forgotten that anxiety is higher in HD patients, it may be appropriate to plan regular meetings with this patient group so that they can express their concerns and receive support from professionals who will provide moral support.

Limitations

The inclusion of patients treated in a single center in the sample and the collection of data during the Covid-19 process are the limitations of the research. Since the research was conducted with only one patient group in a hospital, it cannot represent the whole universe. It can only be generalized to the date and group of the study.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Işın Cantekin

Author Biographies

Rukiye Burucu PhD, Assistant Professor, Necmettin Erbakan University, Seydişehir Kamil Akkanat Faculty of Health Sciences, Department of Medical Nursing Konya/Turkey.

Işın Cantekin PhD Asisstant Professor, Necmettin Erbakan Universty, Seydişehir Kamil Akkanat Faculty of Healthy Sciences, Department of Medical Nursing. Konya/Turkey.

References

Abbas

Kanwal

Saeed

Khan

M. U.

Shahzadi

Faran

(2022). Relationship of Muslim religiosity and death anxiety with the mediating effect of optimism and depression among cancer patients in Pakistan. Journal of Religion and Health, 61(2), 1418–1436. https://doi.org/10.1007/s10943-021-01415-2

Akça

Köse

(2008). Adaptation of death anxiety scale (DAS). Validity and Reliability Studies, 11(1), 7–16.

Al Zaben

Khalifa

D. A.

Sehlo

M. G.

Al Shohaib

Binzaqr

S. A.

Badreg

A. M.

Alsaadi

R. A.

Koenig

H. G.

Koenig

H. G.

(2015). Religious involvement and health in dialysis patients in Saudi Arabia. Journal of Religion and Health, 54(2), 713–730. https://doi.org/10.1007/s10943-014-9962-8

Angın

(2021). Covid-19 pandemi sürecinden geçerken sağlık çalışanlarında dini başa çıkma ve psikolojik sağlamlık i?lişkisi üzerine bir araştırma. Cumhuriyet İlahiyat Dergisi, 25(1), 331–345. https://doi.org/10.18505/cuid.884399

Asadzandi

(2020). Effect of spiritual counseling based on the sound heart model on anxiety of hemodialysis patients. Journal of Nursing Education [Research], 8(4), 76–87. http://ijpn.ir/article-1-1542-en.html

Bibi

Khalid

M. A.

(2020). Death anxiety, perceived social support, and demographic correlates of patients with breast cancer in Pakistan. Death Studies, 44(12), 787–792. https://doi.org/10.1080/07481187.2019.1614108

Burlacu

Artene

Nistor

Buju

Jugrin

Mavrichi

Covic

(2019). Religiosity, spirituality and quality of life of dialysis patients: A systematic review. International Urology and Nephrology, 51(5), 839–850. https://doi.org/10.1007/s11255-019-02129-x

Chen

You

Liu

Kong

Lei

Guo

(2021). Association between spiritual well-being, quality of life, anxiety and depression in patients with gynaecological cancer in China. Medicine (Baltimore), 100(1), Article e24264. https://doi.org/10.1097/MD.0000000000024264

Dadfar

Lester

Abdel-Khalek

A. M.

Ron

(2018). Death anxiety in Muslim Iranians: A comparison between youths, middle adults, and late adults. Illness, Crisis and Loss, 29(2), 143–158. https://doi.org/10.1177/1054137318790080

10.

Dönmez

Ç.

Yılmaz

Helvaci

İ.

(2021). Opinions about death of dialysis patients. West Indian Medical Journal, 69(2), 103–108. https://doi.org/10.7727/wimj.2015.540

11.

Durmuş

Ekinci

(2021). The effect of spiritual care on anxiety and depression level in patients receiving hemodialysis treatment: A randomized controlled trial. Journal of Religion and Health, 61(3), 2041–2055. https://doi.org/10.1007/s10943-021-01386-4

12.

Equador (2019). The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ. https://www.equator-network.org/reporting-guidelines/strobe/. Date of access: 10.12S 2019.

13.

Fekih-Romdhane

Belarbi

Cheour

(2020). The relationship between death obsession and religiosity in non-demented Muslim residents of a nursing home in Tunisia Death obsession and religiosity. Geriatrie et Psychologie Neuropsychiatrie du Vieillissement, 18(1), 103–114. https://doi.org/10.1684/pnv.2020.0875

14.

Frontini

Sousa

Ribeiro

Figueiredo

(2021). “What do we fear the most?”: Exploring fears and concerns of patients, family members and dyads in end-stage renal disease. Scandinavian Journal of Caring Sciences, 35(4), 1216–1225. https://doi.org/10.1111/scs.12940

15.

George

(2019). IBM SPSS statistics 26 step by step: A simple guide and reference (pp. 113–118). Routledge.

16.

Ghiasi

Alidadi

Payandeh

Emami

Lotfinia

(2021). Health-related quality of life and death anxiety among hemodialysis patients. Zahedan Journal of Research in Medical Sciences, 23(2), (In Press), Article e98400. https://doi.org/10.5812/zjrms.98400

17.

Gholami

Asgari

Nasrabadi

S. S. H.

Sadat

Saberi

(2020). The relationship between attitude and practical commitment to prayer and death anxiety in patients with chronic renal failure. Iranian Journal of Psychiatric Nursing, 7(6). https://doi.org/10.21859/ijpn-06043

18.

Harbali

S. M.

Koc

(2022). Psychosocial problems in relation to spiritual orientation and religious coping among oncology Muslim patients. Cancer Nursing, 45(2), 120–131. https://doi.org/10.1097/NCC.0000000000000922

19.

Hashemi

S.-M.

Bouya

Hormozi

Moulaei

Bakhshipour

(2021). Comparison of death anxiety among cancer, hemodialysis, and asthma patients and healthy individuals: A cross-sectional study. Neuropsychiatria i Neuropsychologia, 16(1–2), 82–86. https://doi.org/10.5114/nan.2021.107569

20.

Hosseini

Abdollahzadeh

Ghojazadeh

Jasemi

Parvan

Ahangar

(2015). Coping methods to stress among patients on hemodialysis and peritoneal dialysis. Saudi Journal of Kidney Diseases and Transplantation, 26(2), 255–262. https://doi.org/10.4103/1319-2442.152409

21.

Hosseini

S. M.

Naseri-Salahshour

Farsi

Esmaeili

Sajadi

Maddah

Fournier

(2022). The effect of spirituality-oriented psychological counseling on the fear of death among patients undergoing chronic hemodialysis: A randomized controlled trial. European Journal of Integrative Medicine, 49(1), 102103. https://doi.org/10.1016/j.eujim.2022.102103

22.

Kandemir

(2020). Bazı demografik değişkenler bağlamında Covid19 pandemi neslinin dindarlık ve ölüm kaygısı i?lişkisi üzerine ampirik bir araştırma. Tokat İlmiyat Dergisi, 8(1), 99–129. https://doi.org/10.5281/zenodo.3876200

23.

Khodarahimi

Veiskarami

H. A.

Mazraeh

Sheikhi

Rahimian Bougar

(2021). Mental health, social support, and death anxiety in patients with chronic kidney failure. The Journal of Nervous and Mental Disease, 209(11), 809–813. https://doi.org/10.1097/NMD.0000000000001386

24.

Kimmel

P. L.

Cohen

S. D.

Daniel

(2021). Chapter 8 - anxiety in patients with CKD and ESRD. Psychosocial aspects of chronic kidney disease, (1), 167–181. https://doi.org/10.1016/B978-0-12-817080-9.00008-7

25.

Mina

Kiana

Tayebe

Shima

Seyed Reza

(2018). Association between death anxiety and various aspects of spiritual experiences among elderly people in Iran. Medical Science, 22(93), 478–483. https://www.discoveryjournals.org/medicalscience/current_issue/v22/n93/A8.pdf

26.

Mistik

Ünalan

Kaya

Karaduman

Tokgöz

(2016). Stress coping attitudes of hemodialysis and peritoneal dialysis patients. Turkish Nephrology Dialysis Transplantation, 25(03), 302–308. https://doi.org/10.5262/tndt.2016.1003.15

27.

Nikmanesh

Azaraein

(2017). The role of religious coping in perception of suffering among patients undergoing dialysis. Jundishapur Journal of Chronic Disease Care, Inpress(Inpress), Article e40063. https://doi.org/10.17795/jjcdc.40063

28.

Ü.

(2011). Dini tutum ölçeği: Ölçek geliştirme ve geçerlik çalışması. Uluslararası İnsan Bilimleri Dergisi, 8(2), 528–549. https://www.acarindex.com/dosyalar/makale/acarindex-1423936413.pdf

29.

Ü.

(2016). The ok-religious attitude scale (Islam): Introducing an instrument originated in Turkish for international use. Journal of Beliefs and Values, 37(1), 55–67. https://doi.org/10.1080/13617672.2016.1141529

30.

Othman

E. H.

Khalaf

I. A.

Alosta

M. R.

Abualruz

Zeilani

(2022). Death and dying through the lens of Jordanian Muslim patients and caregivers. Omega (Westport). https://doi.org/10.1177/00302228221133505

31.

Özdamar

(2018). SPSS uygulamalı temel i?statistik. Nisan Kitabevi.

32.

Pollak

J. M.

(1980). Correlates of death anxiety: A review of empirical studies. OMEGA - Journal of Death and Dying, 10(2), 97–121. https://doi.org/10.2190/4KG5-HBH0-NNME-DM58

33.

Rezaei Aderyani

Alimadadi

Hajrahimian

Taheri-Kharameh

(2020). Does spirituality predict death anxiety in chronically ill older adults in a religious context? Journal of Religion, Spirituality and Aging, 33(3), 350–360. https://doi.org/10.1080/15528030.2020.1814936

34.

Sağlam Demirkan

(2020). A study on the relationship between attachment, religious coping, and life satisfaction in dialysis patients. In Istanbul university, institute of social sciences, philosophy and religious sciences, psychology of religion, doctoral dissertation. Istanbul Universty.

35.

Saki

Khoshnood

Mohammadipour

Ebrahimzadeh

Rezaei

(2021). The effect of cognitive–behavioral intervention on hope and death anxiety level in patients undergoing hemodialysis. The journal of mental health training, education and practice, 17(3). ahead-of-print (ahead-of-print) https://doi.org/10.1108/JMHTEP-08-2020-0059

36.

Saleem

(2020). Religiosity and death anxiety: A study of Muslim dars attendees. Journal of Religion and Health, 59(1), 309–317. https://doi.org/10.1007/s10943-019-00783-0

37.

Şanal Karahan

Hamarta

(2019). Geriatrik olgularda kronik hastalıkların ve polifarmasinin ölüm kaygısı ve anksiyete üzerine etkisi. Ege Tıp Bilimleri Dergisi, 2(1), 8–13. https://doi.org/10.33713/egetbd.463608

38.

Seyahi

Ateş

Süleymanlar

(2018). Türkiye’de Renal replasman tedavilerinin güncel durumu: Türk nefroloji derneği kayıt sistemi 2016 yılı özet raporu. Turkish Nephrology Dialysis Transplantation, 27(2), 133–139. https://doi.org/10.5262/tndt.2018.3329

39.

Sharif Nia

Pahlevan Sharif

Koocher

G. P.

Yaghoobzadeh

Haghdoost

A. A.

Mar Win

M. T.

Soleimani

M. A.

(2017). Psychometric properties of the death anxiety scale-extended among patients with end-stage renal disease. OMEGA - Journal of Death and Dying, 80(3), 380–396. https://doi.org/10.1177/0030222817733220

40.

Soleimani

M. A.

Tabiban

Bakhshande

Asghary

(2018). Effect of illness perception intervention on death anxiety in hemodialysis patients: A randomized clinical trial. J Mazandaran Univ Med Sci, 28(162), 12–24. http://jmums.mazums.ac.ir/article-1-10421-en.html

41.

Soriano

G. P.

Calong

K. A. C.

(2022). Religiosity, spirituality, and death anxiety among Filipino older adults: A correlational study. Omega (Westport), 85(2), 445–454. https://doi.org/10.1177/0030222820947315

42.

Steinhauser

K. E.

Fitchett

Handzo

G. F.

Johnson

K. S.

Koenig

H. G.

Pargament

K. I.

Puchalski

C. M.

Sinclair

Taylor

E. J.

Balboni

T. A.

Balboni

T. A.

(2017). State of the science of spirituality and palliative care research Part I: Definitions, measurement, and outcomes. Journal of Pain and Symptom Management, 54(3), 428–440. https://doi.org/10.1016/j.jpainsymman.2017.07.028

43.

Tekkarişmaz

Torun

(2020). Long-term clinical outcomes of peritoneal dialysis patients: 9-year experience of a singlecentre in Turkey. Turkish Journal of Medical Sciences, 50(2), 386–397. https://doi.org/10.3906/sağ-1909-98

44.

Templer

D. I.

(1970). The construction and validation of a death anxiety scale. The Journal of General Psychology, 82(2d Half), 165–177. https://doi.org/10.1080/00221309.1970.9920634

45.

Tepe

(2020). Examination of death anxiety as an existential problem in terms of various variables. In Biruni University Graduate Education Institute Guidance and Psychological Counseling Department Guidance and Psychological Counseling Master’s Degree (pp. 44–52). Buruni Universyt.

46.

Yıldırım Kaptanoğlu

(2013). From hypothesis to thesis in the field of health. In Beşir Bookstore. Beşir Bookstore.