Table 1 Summary table of educational strategies, evaluation methods and effectiveness

Arber [18] UK

To measure 3^rd year students’ knowledge of palliative care before and after a palliative care module

Lecture, and hospice practicum experience

Pretest-posttest

Statistical significant (P = 0.001) increase in knowledge

Frommelt [19] USA

To examine the effects of education on attitude towards care of the dying patient and their families

Lecture, Role play, case study presentations in story formats,

Controlled Pretest-posttest

Significant positive change in attitude for the intervention group t = 7.283, p <0.05

Mallory [20] USA

To assess the impact of education on attitudes towards care of the dying

Lectures, group discussions, Role play, visit to a gross anatomy cadaver laboratory, funeral home and hospice

Controlled pretest- posttest longitudinal

Significant improvements (p < .05) in attitude score in the intervention group

Thompson [21] USA

To assess the degree of change in comfort level in the care of the dying that students experience during a palliative care course

Interactive lectures, online discussion, reading of recommended books, field trips to a funeral home, role playing, journaling of experiences

Pretest-posttest

Increase in comfort levels from an average of 4.8 before to 7. 5 after

Kwekkeboom et al. [22] USA

To assess the impact of a volunteer companion program on students’ knowledge, attitudes and concern caring for a dying patient

Orientation lecture, spending time with patients and their families, making up bereavement phone calls to families of patients previously cared for, keeping Journal of experiences

Controlled pretest- posttest

No significant change in knowledge; Significant decrease in concerns scores P <0.01 Attitude scale not assessed due to poor reliability

Brien et al. [23] Canada

To develop effective nursing competencies for end of life care among undergraduate student nurses.

Plenary reflective activities, viewing of a documentary film and participating in role-playing simulations.

Mixed Method

Attitudes related to apprehensions and beliefs regarding interventions with dying persons and their families changed positively for most students.

Barrere et al. [24] USA

To assess the influence of integrating the ELNEC curriculum into a 1 year and 4 years baccalaureate program on students’ attitudes toward care of the dying

Lecture, discussions, clinical placement experience in the care of the dying in hospitals, homes, extended care facilities and hospices

Pretest-posttest

Type of program not significant in attitude change. Significant improvements in attitudes, t = -5.977, p = .000

Leighton et al. [13] USA

To facilitate application of theory content to a clinical end-of-life scenario.

Simulated end of life care clinical experience.

Qualitative

Helped students to look at grief in a different way, students found interacting with grieving family members to be rewarding Real nature of the simulation enhanced students’ learning.

Dibartolo et al. [25] USA

To enhance student knowledge of the dying process and the complexity of human reactions when facing EOL situations

An assignment using Cinemeducation approach in which students were asked to view either of these two films: Tuesdays with Morrie or Whose Life Is It Anyway? and to answer some questions relating to the film as well as describe lessons learned from the film that could be used in their practice in similar situations

Not clear

Most students felt assignment was helpful in identifying pertinent issues about end of life care. The responses to the assignment questions submitted by students were good in quality and insight with grades ranging from A to D, and a majority with B. Students could identify the stages of grief.

Weismann et al. [26] USA

To examine effect of ENLEC communication module on first years ADN students self-efficacy in communication skills

Lecture, group discussion, Role play Listening to a classmate describe a significant loss in his/her life,case study

Controlled pretest-posttest

Significant improvements in the intervention group on both the scores on the VAS and FATCOD. Also there was improvements in the controls group’s score on the VAS and FATCOD, indicating both approaches are effective

To determine if a specially prepared palliative care module and an embedded content course lead to positive attitude towards care of the dying patient

Dobbin [27] USA

To assess the impact of an elective nursing course incorporating the ENLEC curriculum content on associate degree student nurses’ attitudes towards death and care of the dying

Lecture with PowerPoint slides (for students in the intervention groups) supplemental text, visit to a hospice and funeral home Watching of the film ‘Wit’ (students in elective course), reference palliative care content of a medical-surgical book

Controlled pretest-posttest

Both content delivery methods were found to change students’ attitude towards death to an extent. However, students who watched the film Wit recorded significant positive changes

To evaluate the effect of an end-of-life module embedded in a larger course on the attitudes of a similar group of students.

Gilliland [28] USA

To examine the effect of a planned clinical experience with dying patients on student attitudes and self-perceived competencies in end-of-life care.

2 days hospice experience

pretest-posttest

Significant change in attitude. No significant change in self-reported end of life care competencies

Bush T [29] Australia

To determine if the completion of a palliative care elective aided nursing students in the clinical provision of palliative care

Lectures and end of life care simulation

Posttest-only

Students reported that the course was beneficial to their learning about end of life care and appreciated the inclusion of palliative care in their program

Eaton et al. [30] USA

To explore the perceived influence of an end of life care simulation on students’ learning in home health and hospice practicum setting

End of life care simulations and debriefing session

Descriptive Phenomenology

Students reported that gaining experience in a safe environment prior to practice placement had a positive impact

Moreland et al. [31] USA

To evaluate the effect of a 15-minute simulation involving a terminally ill lung cancer patient on student nurses knowledge of end-of-life signs and symptoms and perceived self-efficacy

End of life care simulations and debriefing session

Mixed method

11% increase in overall knowledge and self-efficacy improved significantly post-simulation from 35.36 to 37.79 (p = .05). Students expressed difficulty with changing their perspectives from curing to caring for the dying client.

Fluharty et al. [32] USA

To assess whether there will be an increase in students’ end of life care knowledge, self-confidence in the care of the dying and self-reported communication skills in working with end of life patients after participating in an end of life care simulation

Voice over PowerPoint lecture prepared by an ENLEC Instructor, end of life care simulation experience, debriefing and guided reflection

Pretest-posttest

Students demonstrated significant increase in knowledge (from pretest mean of 7.98 to posttest mean of 9.15), self-confidence (mean of 6.88, SD 0.61) and self-reported communication skills (mean of 4.33, SD 0.56) in end of life care.

Pullis [33] USA

To prepare students to care for dying patients and their families.

End of life care orientation lecture and hospice clinical experience as part of a community health nursing course

Not clear

Students were able to demonstrate the: principles of pain and symptom management, ability to communicate the goals and philosophy of hospice care and to advocate for individuals at the end of life