Death Literacy and End-of-Life Preparedness Among Health Professions Students: A Mixed-Methods Study

Background: Health professions students frequently encounter death and dying in clinical settings, yet many report limited preparedness for end-of-life care. Death literacy offers a multidimensional framework for understanding knowledge, experiential learning, communication competence, and navigating systems related to death and bereavement. The objective of this study was to examine predictors of death literacy among health professions students and evaluate differences across program types. Methods: A cross-sectional, convergent mixed-methods survey was conducted among health professions students at the University of Georgia and Nova Southeastern University. Quantitative measures included the Death Literacy Index-9 (DLI-9) and single-item predictors assessing formal education, communication comfort, experiential exposure to death, perceived program preparedness, and awareness of community resources. Multivariate linear regression identified independent predictors of death literacy. One-way analysis of variance (ANOVA) was used to examine differences by program. Open-ended responses were analyzed thematically and integrated at interpretation. Results: A total of 326 completed surveys were analyzed. The mean DLI-9 score was 47.0 (SD = 18.9). The regression model was significant (F(5,312) = 59.25, p < .001), explaining 48.7% of variance in death literacy. Greater comfort discussing death was the strongest predictor (β = .435, p < .001), followed by awareness of community resources (β = .226, p < .001), formal education (β = .147, p < .001), perceived preparedness (β = .145, p = .001), and personal experience with death (β = .105, p = .011). Death literacy differed significantly by program (p < .001), with pharmacy students reporting lower scores. Qualitative findings highlighted the perceived importance of death literacy alongside gaps in formal training and experiential learning. Conclusions: Communication comfort, educational exposure, and systems awareness are central predictors of death literacy among health professions students. Interprofessional, experiential curricula may strengthen end-of-life preparedness across disciplines.