Hospice care knowledge and death attitude profiles among hospital-based healthcare workers: a latent profile analysis

Healthcare workers' attitudes toward death may influence end-of-life care delivery. However, heterogeneity in these attitudes and their relationship with hospice care knowledge remain insufficiently understood.

A cross-sectional survey was conducted among 1,421 hospital-based healthcare workers from secondary and tertiary hospitals in Zhejiang Province, China. Death attitudes were assessed using the Death Attitude Profile-Revised (DAP-R), and hospice care knowledge was measured using a structured self-developed questionnaire. Latent profile analysis was applied to identify distinct death attitude profiles. Multinomial logistic regression was used to examine associations between hospice care knowledge, demographic and occupational characteristics, and profile membership.

The sample was predominantly composed of nurses (93.8%). Three distinct death attitude profiles were identified: a less adaptive profile characterized by lower acceptance and higher fear or avoidance, a moderate profile with intermediate levels across dimensions, and a high adaptive profile marked by higher acceptance and lower fear-related responses. Hospice care knowledge demonstrated a consistent graded association with profile membership, with higher knowledge scores associated with increased likelihood of belonging to more adaptive profiles. In contrast, demographic and occupational characteristics were not independently associated with profile membership after adjustment. Overall hospice care knowledge levels were relatively low across the sample.

Hospital-based healthcare workers exhibited substantial heterogeneity in death attitudes. Higher hospice care knowledge was consistently associated with more adaptive death attitude profiles. Although causal inferences cannot be drawn due to the cross-sectional design, these findings highlight the potential relevance of hospice and palliative care education in supporting workforce preparedness for end-of-life care. Future longitudinal and interventional studies are needed to clarify the directionality of these associations.