The contribution of a MOOC to community discussions around death and dying

BackgroundAdvances in medicine have helped many to live longer lives and to be able to meet health challenges. However death rates are anticipated to increase given the ageing population and chronic disease progression. Being able to talk about death is seen to be important in normalising death as part of life and supporting preparedness for death. Massive Open Online Courses (MOOCs) provide opportunities for the community to engage in collaborative learning. A 5 week MOOC was developed covering four main topics (language and humour, representations of death, medicalisation of dying, and digital dying) aiming:To enable participants to openly and supportively discuss and learn about issues around living, death and dying,To explore the normally unheard opinions and views of Australians around death and dying, andTo determine what effect online learning and discussions offered through the MOOC had on participants’ feelings and attitudes towards death and dying.MethodsData was captured on engagement rates in the various MOOC activities. Death Attitudes were measured by five items representing the MOOC’s learning objectives and completed at enrolment and conclusion. MOOC Satisfaction was measured with six items at the end of the MOOC. Descriptive statistics were produced for each variable and Chi-Square Tests of Independence assessed the extent of the relationship between categorical variables. Socio-demographic variables were examined as predictors of the outcome variables of MOOC engagement, MOOC satisfaction, and death attitudes. Ethical approval was received from Flinders University Social and Behavioural Research Ethics Committee (Project No. 7247).ResultsOne thousand one hundred fifty six people enrolled in the Dying2Learn MOOC with 895 participating in some way. Enrolees were primarily female (92.1%). Age ranged from 16 to 84 (mean = 49.5, SD = 12.3). MOOC satisfaction scores were high. Responses to the experience of participating in the MOOC were very positive, with mean scores ranging from 4.3 to 4.6 (aligning with agreement and strong agreement to statements on the value of participating). Death Attitudes were positive at commencement but increased significantly following participation.ConclusionsThe Dying2Learn MOOC provided an environment that enabled open and supportive discussion around death and dying and influenced attitudinal change.

[1]  S. Guthridge,et al.  Socio-economic indexes for areas (SEIFA) of administrative health districts and urban centres/localities in the Northern Territory , 2005 .

[2]  S. Barclay,et al.  Do Patients Want to Die at Home? A Systematic Review of the UK Literature, Focused on Missing Preferences for Place of Death , 2015, PloS one.

[3]  Joseph Jay Williams,et al.  HarvardX and MITx: Two Years of Open Online Courses Fall 2012-Summer 2014 , 2015 .

[4]  D. Clark,et al.  Interventions at the end of life – a taxonomy for ‘overlapping consensus’ , 2017, Wellcome open research.

[5]  Stephen Marshall,et al.  Exploring the ethical implications of MOOCs , 2014 .

[6]  Jason Mills,et al.  Building community capacity for end of life: an investigation of community capacity and its implications for health-promoting palliative care in the Australian Capital Territory , 2015 .

[7]  J. Katz,et al.  The impact of a distance learning death and dying course: an analysis of student self-reported changes. , 2005, Nurse education today.

[8]  D. Heyland,et al.  Engaging the Public to Identify Opportunities to Improve Critical Care: A Qualitative Analysis of an Open Community Forum , 2015, PloS one.

[9]  Magnolia Cardona-Morrell,et al.  A systematic review of effectiveness of decision aids to assist older patients at the end of life. , 2017, Patient education and counseling.

[10]  Debbie Horsfall,et al.  Developing death literacy , 2016 .

[11]  K. Hurrelmann,et al.  Health literacy among different age groups in Germany: results of a cross-sectional survey , 2016, BMC Public Health.

[12]  P. Butow,et al.  Advance care planning for cancer patients: a systematic review of perceptions and experiences of patients, families, and healthcare providers , 2016, Psycho-oncology.

[13]  Thoughts about Dying in America: Enhancing the impact of one’s life journey and legacy by also planning for the end of life , 2016, Proceedings of the National Academy of Sciences.

[14]  Neil P. Morris,et al.  Comments in MOOCs: who is doing the talking and does it help? , 2017, J. Comput. Assist. Learn..

[15]  J. Tieman Ensuring Quality in Online Palliative Care Resources , 2016, Cancers.

[16]  H. Noble,et al.  Public awareness and attitudes toward palliative care in Northern Ireland , 2013, BMC Palliative Care.

[17]  A. Kellehear Commentary: Public health approaches to palliative care – The progress so far , 2016 .

[18]  S. McLachlan,et al.  Initial perceptions of palliative care: An exploratory qualitative study of patients with advanced cancer and their family caregivers , 2017, Palliative medicine.

[19]  W. Stanton,et al.  Public attitudes to death and dying in the UK: a review of published literature , 2012, BMJ Supportive & Palliative Care.

[20]  J. Tieman,et al.  Supporting service change in palliative care: a framework approach. , 2014, International journal of palliative nursing.

[21]  Ellen Uiters,et al.  Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU) , 2015, European journal of public health.

[22]  E. Flynn,et al.  Death: a foe to be conquered? Questioning the paradigm. , 2015, Age and ageing.

[23]  Jolie Kennedy,et al.  Characteristics of Massive Open Online Courses (MOOCs): A Research Review, 2009-2012. , 2014 .

[24]  Allison Littlejohn,et al.  Instructional quality of Massive Open Online Courses (MOOCs) , 2015, Comput. Educ..

[25]  Antonella Esposito,et al.  Research Ethics in Emerging Forms of Online Learning: Issues Arising from a Hypothetical Study on a MOOC. , 2012 .

[26]  F. Murtagh,et al.  The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: A systematic review of views from patients, carers and health-care professionals , 2014, Palliative medicine.

[27]  Lindsay B. Carey,et al.  Circles of care: should community development redefine the practice of palliative care? , 2013, BMJ Supportive & Palliative Care.

[28]  Katy Jordan,et al.  Massive Open Online Course Completion Rates Revisited: Assessment, Length and Attrition , 2015 .

[29]  C. Hill,et al.  Functional health literacy mediates the relationship between socio-economic status, perceptions and lifestyle behaviors related to cancer risk in an Australian population. , 2013, Patient education and counseling.

[30]  S. Duckett,et al.  What can we do to help Australians die the way they want to? , 2015, The Medical journal of Australia.

[31]  A. Kellehear,et al.  Palliative care reimagined: a needed shift , 2016, BMJ Supportive & Palliative Care.