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

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.