Courage and representations of death in patients who are waiting for a liver transplantation

Context: In the last decade, a wide literature has highlighted the importance of religiosity as support of severe illnesses, especially the oncological ones, and in the end of life. In the field of the liver transplant there is a lack of similar research. This article aims to bridge this gap and presents an exploratory study on the relationships between fear of death, courage and religiosity among patients who wait for liver transplant. Method: Sixty-two participants awaiting a liver transplant were interviewed with regard to their quality of life, religiosity, ontological representations and fear of death, courage and fear of intervention, donor-related thoughts. The following instruments were utilized: a specific interview; the Short Form Health Survey (SF-36); the Testoni Death Representation Scale (TDRS) and the Courage Measure. Results: Patients reporting higher levels of fear for intervention showed less courage and were more likely to avoid the surgery. They also tended to be non-believers, to have a lower quality of life, and to represent death as an absolute annihilation. Conclusions: The less death was represented as a passage, the stronger the avoidance behaviour and the fear of transplant were. Since it is possible to develop a positive thought about death, the study underlined how the spiritual support could be useful to manage fear of transplantation.