Palliative Care Knowledge, Attitudes, and Practices Among Nurses in a Secondary Hospital in Shanghai

Summary

This study describes a standardized protocol to evaluate palliative care knowledge, attitudes, and practices among nurses in secondary hospitals, identifies key associated factors, and highlights targeted training needs to improve the quality of palliative care delivery.

Abstract

Palliative care needs are increasing rapidly in China, yet the preparedness of nurses working in secondary hospitals has been less well characterized than that of staff in tertiary institutions. This cross-sectional study evaluated palliative care knowledge, attitudes, and practices among nurses in a district-level secondary hospital in Shanghai and examined factors associated with performance in this setting. In February 2024, 520 nurses were invited to complete a structured questionnaire covering demographic characteristics and three palliative care domains: knowledge, attitudes, and practices. Data were analyzed using descriptive statistics, group comparisons, correlation analysis, and multivariable regression. Nurses showed relatively favorable attitudes and knowledge, with mean standardized scores of 83.79 and 83.48, respectively, whereas the standardized practice score was lower at 76.71. Knowledge, attitudes, and practices were positively correlated with one another (P < 0.05). Age, marital status, education level, years of service, prior caregiving experience, and participation in palliative care training were independently associated with at least one KAP domain. In particular, caregiving experience and prior training were associated with stronger practice performance. These findings indicate that, even when baseline knowledge and attitudes are acceptable, translation into practice remains incomplete in secondary hospitals. The protocol provides a replicable approach for evaluating palliative care readiness in this understudied care setting and supports the development of targeted training and institution-level implementation strategies.

Introduction

Population aging has intensified the need for palliative care worldwide. Palliative care aims to relieve suffering and improve quality of life for patients with life-limiting illness and their families through symptom control, communication, and psychosocial support¹. In China, this need is becoming more urgent as the population aged 60 years and older reached nearly 297 million by the end of 2023, accounting for 21.1% of the national population². Despite growing demand, palliative care capacity remains unevenly distributed across institutions and regions, and workforce preparedness continues to limit implementation.

....

Protocol

This study was approved by the Medical Ethics Committee of Baoshan Branch, Renji Hospital, Shanghai Jiao Tong University School of Medicine under approval number 2024-B-027. The survey was conducted in accordance with institutional ethical requirements for anonymous questionnaire research. Before accessing the questionnaire, all participants viewed an electronic information page describing the study purpose, target population, voluntary nature of participation, expected completion time, confidentiality measures, and the right to withdraw at any time before submission. Only participants who selected the electronic consent option were allowed to proceed to the formal qu....

Results

Data quality control and sample characteristics

During the survey period, a total of 537 questionnaires were returned. All returned records were exported from the survey system and screened according to the predefined validity rules described in the Protocol section. After quality control, 520 questionnaires were retained for final analysis, corresponding to an effective response rate of 96.83%. Among the 17 excluded questionnaires, 4 were identified as duplicate or near-dupli.......

Discussion

The present study showed that nurses working in a secondary hospital in Shanghai generally reported relatively positive knowledge of and attitudes toward palliative care, whereas practice scores remained comparatively lower^8,9. This overall pattern is broadly consistent with earlier domestic findings, although the levels observed in the present study were higher than those reported in some previous studies^10,11.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Blank participant information sheet	Self-developed study document	N/A	Provided study purpose, voluntary participation statement, confidentiality statement, and survey instructions before participation.
De-identified raw response dataset (.csv)	Generated during the study	N/A	Exported in comma-separated values format for screening, coding, and analysis.
Electronic informed consent form	Self-developed study document	N/A	Displayed on the first page of the survey; participants could proceed only after indicating consent.
LibreOffice Calc	The Document Foundation	LibreOffice 26.2.2	Used for initial inspection of exported response files, variable checking, coding verification, and preparation of analysis-ready tables. LibreOffice 26.2 is listed by the project as the latest stable release, and 26.2.2 is available as a current release build.
LimeSurvey Community Edition	LimeSurvey GmbH	6.16.15	Open-source survey platform used to build the questionnaire, distribute the survey through a secure web link or QR code, enforce required responses where applicable, and export collected data. LimeSurvey lists Community Edition 6.16.15 as the current version and describes CE as self-hostable open-source survey software [oai_citation:4‡LimeSurvey].
QR code for survey link	Generated within LimeSurvey or a local QR generator	N/A	Used to allow participants to open the questionnaire on a mobile device.
R	R Foundation for Statistical Computing	4.5.3	Open-source statistical computing environment used for descriptive statistics, correlation analysis, and multiple linear regression.
R package: psych	William Revelle / CRAN	2.6.3	Used for internal consistency analysis, including Cronbach’s alpha and related psychometric summaries.
Statistical analysis script (.R)	Self-developed study file	N/A	Contains reproducible commands for data import, cleaning, descriptive analysis, Pearson correlation, reliability testing, and linear regression.
Study codebook / variable dictionary	Self-developed study document	N/A	Defines variable names, labels, coding rules, reverse scoring if applicable, and valid-response criteria.
Survey questionnaire file (.lss or .pdf)	Self-developed study file	N/A	Archived copy of the questionnaire structure for reuse or independent verification. LimeSurvey CE supports exchange of survey structures in reusable formats [oai_citation:7‡LimeSurvey].
Web browser	Mozilla Foundation	Firefox ESR 128.1	Used by investigators to administer the survey platform and by participants to access the web questionnaire. Exact build should match the local installation used during the study.