The Effect of Forgiveness-based Motivational Interviewing on Death Anxiety, Life Satisfaction, and Forgiveness Disposition in Patients With COPD: A Randomized Controlled Trial

Chronic obstructive pulmonary disease (COPD) is a global chronic respiratory disease that arises from a combination of genetic and environmental factors, predominantly due to smoking and air pollution.As the disease progresses, symptoms such as dyspnoea, cough, and sputum production emerge, leading to several complications, including fatigue, insomnia, social withdrawal, and anxiety. The persistent presence of these symptoms can result in intense death anxiety among COPD patients. Studies on COPD patients in the literature suggest that the prolonged duration of the disease, continuous medication use, and the burden of disease-related symptoms negatively impact their quality of life, ultimately reducing their life satisfaction. This decline in life satisfaction can, in turn, give rise to a diminished sense of hope for the future and an escalation in death anxiety. Moreover, COPD patients frequently encounter emotional distress during treatment and care, undergo a critical reassessment of their past lives, and grapple with feelings of guilt and regret. The management of these emotions can be arduous. In this context, the concept of forgiveness emerges as a potential mitigating factor for the adverse emotional effects of the disease. Forgiveness is not about denying the pain and consequences of a distressing experience but rather an effort to replace feelings of anger, resentment, and bitterness with compassion, empathy, and kindness. To date, no studies have specifically examined forgiveness training for COPD patients; however, previous research indicates that motivational interviewing has positive effects on various patient populations. Motivation can be defined as an internal state influenced by external factors. Motivational interviewing is a client-centred and encouraging approach that helps individuals explore and resolve ambivalence to facilitate behaviour change. Motivational interviewing not only supports behavioural and lifestyle changes in patients but also enhances their adherence to treatment. Beyond the necessity of treating physical symptoms in individuals with chronic diseases like COPD, the need for psychological support underscores the importance of consultation-liaison psychiatry. Consultation-liaison psychiatry (CLP) nurses do not merely provide care services; they also assume advisory and educational roles by conducting individual or group psychoeducation sessions. CLP nurses should support patients in expressing emotions such as anger, guilt, sadness, and regret, strengthen their coping mechanisms, mobilise effective support systems, and increase awareness of the impact of these emotions on their lives. In consideration of the role of CLP nurses, it can be posited that forgiveness-based motivational interviewing for COPD patients may prove efficacious in reducing death anxiety, increasing life satisfaction, and enhancing forgiveness tendencies, while concomitantly addressing their need for care, education, and counselling.