Successful Outcomes, Fulfilment, and Positive Affect: Establishing Facets of Eustress Across Real-Life Challenging Situations.

Due to a growing population of frail older people and people with serious illness, the demand for palliative and end-of-life care is rising. To face this public health challenge, approaches such as creating Compassionate Communities have emerged, which reserve a larger role for community members in the provision of care and support for people confronted with serious illness, death, dying, and loss. To be able to provide end-of-life care and support, community members may benefit from death literacy, the knowledge and skills that enable individuals to gain access to, understand, and act upon end-of-life and death care options. Death literacy comprises four dimensions: (1) factual knowledge about health services and policies, medical procedures and end-of-life planning; (2) practical knowledge (skills) in personal care, talking about death and dying, negotiating with health and other service providers, and care and disposal of the body; (3) experiential learning, whereby attitudes and beliefs towards death and care around the end of life are transformed by being actively involved in caring; and (4) community capacity (for social action) whereby people can share knowledge and skills from caring experiences with their networks. The conceptualisation of death literacy as a resource suggests that by accumulating death literacy, individuals and communities may benefit from a protective effect on their well-being and self-efficacy. In their recent report, the Lancet Commission on the Value of Death explicitly recommended the development of death literacy for all. However, to increase death literacy, insight is needed into how individuals become death literate. Research on the topic remains limited: beyond the association with end-of-life (care) experience little is known about how death literacy develops. It remains to be empirically shown which pathways, beyond lived experience, lead to death literacy and which factors contribute to its development. An integrated causal model may provide a foundation for further research and for interventions aimed at increasing death literacy. The objective of this study is to develop an evidence-informed conceptual model that summarizes key domains and theorised relationships involved in death literacy development. Building on a review of the literature and expert opinions, this study aims to answer the following specific research questions: 1) What are the determinants of death literacy?; And 2) what factors influence the relationship between death literacy and its determinants?