How does the general public perceive hospice and palliative care? -an empirical study from China

Global aging and rising chronic disease burden have made hospice and palliative care (HPC) a healthcare priority. China has initiated three rounds of HPC pilot programs covering two-thirds of its cities, yet public utilization remains low. Understanding public knowledge, attitude, and preference (KAP) toward HPC is essential to overcoming adoption barriers and fostering acceptance.

To empirically evaluate public KAP for HPC, pinpoint influencing factors, and offer targeted strategies to address challenges.

This cross-sectional study assessed public KAP using the culturally adapted Public Knowledge, Attitude, and Preference of HPC Scale (P-KAPHPCs). Regression analysis was applied to identify factors associated with KAP. A structural equation model was constructed to test their interrelationship.

Among all the respondents, the mean score for HPC knowledge was 7.47 ± 2.14, with 41.10% of the respondents could explain HPC. Educational level and household income were associated factors of knowledge (p < 0.05). The overall attitude mean score rate was 84.18%. Public attitude toward end-of-life (EOL) arrangements for terminally ill patients was significantly influenced by age, attitude toward one's own EOL care were affected by educational level (p < 0.05). The majority (67.80%) declined life-sustaining treatment (LST), with preference linked to gender, occupation, experience of witnessing a patient's EOL process, primary family decision-makers, and family size (p < 0.05). Most respondents (47.30%) preferred home as the place for the EOL care. Structural equation modeling analysis showed that knowledge was positively associated with attitude (β = 4.97, p < 0.001) and knowledge was positively associated with preference (β = 0.22, p < 0.001).

The public attitude toward HPC is generally positive, though there is a need to improve the quality of public knowledge, and preference varies. Knowledge has a positive influence on both attitude and preference. Traditional cultural values and ethics sometimes create conflicts in HPC decision-making. Therefore, it is recommended to strengthen HPC education, enhance legal protections for advance care planning (ACP) and advance directives (AD), introduce culturally appropriate family consensus communication tools, and establish a home-community hybrid care model.