Death anxiety and its associated factors among palliative care nurses in China: a multicenter cross-sectional study

To investigate the current status of death anxiety among palliative care nurses, explore its associated factors based on the Conservation of Resources theory, and provide an empirical reference to inform future targeted clinical interventions.

A multicenter cross-sectional study was conducted among certified palliative care nurses affiliated with 44 hospitals across Shanxi Province, China. The survey link was broadly distributed to all certified palliative care specialist nurses who had completed the standardized training program organized by the Shanxi Nursing Association. Ultimately, 318 valid questionnaires were obtained from nurses affiliated with 44 hospitals (valid questionnaire rate = 95.21%). Data were collected using a general information questionnaire, the Chinese version of Templer-Death Anxiety Scale (CT-DAS), the Positive Psychological Capital Questionnaire (PPQ), and the Perceived Organizational Support Scale (POS). Theory-driven hierarchical linear regression analysis was performed to examine factors associated with death anxiety.

The median total score for death anxiety among the palliative care nurses was 45.00 (IQR: 44.00-47.00), with 95.0% (n = 302) scoring above the screening cutoff (≥ 35) for high death anxiety. Hierarchical linear regression analysis (R² = 0.660, P < 0.001) revealed that age, female gender, having no children, higher monthly income (≥ 8,000 RMB), and a nursing tenure of ≥ 5 years were positively associated with death anxiety, whereas positive psychological capital and perceived organizational support were negatively associated with death anxiety (all P < 0.05).

A substantial proportion of palliative care nurses experienced high death anxiety, which was statistically associated with a combination of sociodemographic, occupational exposure, and psychological and organizational resource factors. Given the cross-sectional design, these findings are hypothesis-generating. Future longitudinal and interventional studies are warranted to verify these associations and evaluate whether strengthening psychological and organizational resources can effectively mitigate death anxiety and support nurse well-being.