Enhancing end-of-life communication in Chinese first-year nursing students: A mixed-methods study of a culturally...

To develop and evaluate a culturally sensitive end-of-life communication course for first-year nursing students, grounded in Kolb's experiential learning theory.

Global ageing and multimorbidity have intensified the need for effective end-of-life communication, but in China, cultural taboos and limited training hinder its development.

A quasi-experimental, cluster-randomized mixed-methods study was conducted.

A total of 114 first-year nursing students across four classes were cluster-randomized into an intervention (n = 59; EOLC course) or control group (n = 55; traditional lectures). Pre- and post-tests and between-group comparisons were used to assess learning outcomes. Reflective writings from the intervention group were analysed qualitatively using content analysis.

Post test comparisons showed significant improvements in communication knowledge (MD = 4.36, p = 0.003) and skills (MD = 4.34, p = 0.001). Compared with the control group, the intervention group showed significantly greater improvements in end-of-life care attitudes (β = 7.29, p = 0.028) and positive attitude toward communication skills learning (β = 3.43, p = 0.012). However, the intervention group's attitude toward caring for the dying person's family significantly decreased after the program (MD = - 1.19, p < 0.05). Qualitative analysis complemented the quantitative findings, revealing five themes that reflected students' evolving understanding and professional development.

Within the context of this study, an experiential, culturally tailored end-of-life communication course was associated with enhanced nursing student competencies and attitudes. These findings suggest that introducing such programmes earlier in training may better equip students to provide effective end‑of‑life care in the future.