Empathy and Attitudes Toward Palliative Care Among Chinese Medical Students: A Cross-Sectional Study

Empathy and Attitudes Toward Palliative Care Among Chinese Medical Students: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Empathy and Attitudes Toward Palliative Care Among Chinese Medical Students: A Cross-Sectional Study Cengceng Lu, Jing Li, Huan Chen, Yue Zhao, Min Ding, Yan Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6614595/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Palliative care is increasingly recognized worldwide for improving the quality of life of patients with life-threatening illnesses and their families. However, in China, palliative care education is often marginalized, and limited research has examined how medical students’ empathy levels and personal characteristics influence their attitudes toward palliative care. Methods A cross-sectional study surveyed 546 undergraduate students from clinical medicine, nursing, and related majors at a Chinese medical university, with 463 valid responses analyzed (response rate: 84.8%). Data were collected using an online questionnaire incorporating demographic measures, the Chinese version of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD-B), and the Interpersonal Reactivity Index-Chinese version (IRI-C). Statistical analyses included descriptive statistics, Pearson correlation, and multiple linear regression. Result The mean attitude score toward palliative care was 96.16 ± 10.82, and the mean empathy score was 52.93 ± 11.25, indicating moderate levels. Empathy was significantly positively correlated with attitudes toward palliative care (r = 0.378, p -value < 0.01), with the Fantasy subdimension showing the strongest association. Regression analysis identified better family atmosphere, bereavement experience, and volunteer or part-time work as significant predictors of both empathy and attitudes. Conclusion Integrating empathy training and experiential learning into medical curricula may enhance Chinese medical students’ preparedness to deliver compassionate end-of-life care, highlighting the need for targeted palliative care education reforms. Hospice Palliative Care Attitude Dying patients Empathy Undergraduate Medical Students Background Palliative care, which focuses on improving the quality of life for patients with life-threatening illnesses and supporting their families, has become an increasingly vital component of healthcare worldwide. Importantly, this approach extends its support not only to patients but also to their families, both during the patient’s life and after their death( 1 ). The Lancet Global Health projects that by 2060, approximately 48 million people - representing 47% of all global deaths - will die while experiencing serious health-related suffering, reflecting an 87% increase from 26 million cases in 2016. Notably, 83% of these deaths will occur in low- and middle-income countries, with the most pronounced rise expected in low-income countries, where the burden is projected to increase by 155% between 2016 and 2060 ( 2 ). Despite these global trends, palliative care education in China has lagged behind, often marginalized within medical curricula and typically offered as elective rather than core coursework ( 3 – 7 ). Combined with the influence of traditional cultural values, such as filial piety, and a societal reluctance to discuss death openly, the development and acceptance of hospice and palliative care in China face considerable challenges. Empathy is a multidimensional construct comprising both cognitive and affective components. It is defined as the ability to adopt and understand another person’s perspective, share in their emotional experiences, and convey warmth and acceptance. Cognitive empathy refers to an individual’s capacity to recognize another person’s condition and infer their thoughts, perspectives, and emotions from a psychological standpoint, while affective empathy involves emotional responsiveness and concern for the feelings and well-being of others ( 8 ). Medical students, as future healthcare providers, play a pivotal role in shaping the future landscape of palliative care services. Their attitudes toward palliative care and their empathy levels are crucial factors that influence their willingness and ability to deliver compassionate, patient-centered end-of-life care ( 1 , 9 – 11 ). Although previous studies have examined these aspects in other countries ( 12 – 17 ), there is limited research focused specifically on Chinese medical students, particularly regarding how their personal characteristics, educational experiences, and empathy levels interact to shape their attitudes toward palliative care. This study aims to assess the attitudes of Chinese medical students toward palliative care, measure their empathy levels, and explore the relationship between these two constructs. In addition, the study investigates how individual characteristics - including demographic factors, personal experiences, and academic background - influence these outcomes, with the goal of providing evidence-based recommendations for improving palliative care education and training in China. Methods Study population and sample This study employed a convenience sampling method. From January to March 2024, undergraduate students majoring in clinical medicine, nursing, and related disciplines from first to fourth/fifth year at a medical college in Shihezi were recruited. Inclusion criteria were as follows: ( 1 ) full-time undergraduate medical students admitted through the National College Entrance Examination who were currently enrolled in the first to fourth/fifth year of a medical program; ( 2 ) individuals without psychiatric or cognitive disorders and capable of understanding the questionnaire content; and ( 3 ) students who provided informed consent and voluntarily agreed to participate. Exclusion criteria included: ( 1 ) students diagnosed with psychiatric or psychological disorders; and ( 2 ) those enrolled in non-medical majors, or who had suspended their studies, dropped out, or joined the military during their academic program. The study included a total of 65 independent variables, comprising 14 items related to general demographic information, 29 items assessing attitudes toward palliative care, and 22 items measuring empathy levels. According to the general rule of thumb that the sample size should be 5 to 10 times the number of parameters to be estimated ( 18 ), the required sample size was estimated to range between 325 and 650 participants. To accommodate potential issues such as low-quality responses and sample attrition, and to ensure an adequate number of valid questionnaires for statistical analysis, the final sample size was determined by multiplying the number of variables by 7 and adding an additional 20%. As a result, the target sample size was set at 546 participants. Data collection Ethical approval was obtained from the Ethics Committee of the First Affiliated Hospital of Shihezi University prior to data collection. The university subsequently facilitated access to medical students by coordinating communication efforts. The role of university facilitators was limited to announcing the study and its purpose via student boards and social media groups. A standardized instruction was used to explain the purpose of the study and the guidelines for completing the questionnaire to all participants, and informed consent was obtained prior to participation. Interested students were invited to contact the researcher, who explained the study's purpose and significance, and emphasized that participation was entirely voluntary. Participants were assured that refusal to participate would not affect their academic status in any way. The researcher also addressed issues of anonymity, privacy, and confidentiality, and informed students of their right to withdraw from the study at any time. The questionnaire was distributed and collected via the online platform "Questionnaire Star" ( www.wjx.cn ). A total of 546 questionnaires were distributed, of which 463 were valid, yielding an effective response rate of 84.8%. Digital data were stored on a password-protected computer. Measurement instruments A self-designed general information questionnaire was employed to assess the participants general characteristic, including gender, year of study, major, only child status, place of origin, age, internships or training experience with hospice palliative care, participation in volunteer service, family atmosphere, highest parental education level, religious affiliation, experience of bereavement, and previous experience in caring for terminally ill patients and their families. The Chinese version of the Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B) was employed to assess medical students’ attitudes toward caring for dying patients. This instrument has demonstrated good construct validity, concurrent validity, convergent validity, and internal consistency in previous studies ( 19 ). The FATCOD is one of the few psychometric tools specifically designed to measure attitudes toward end-of-life care among healthcare students ( 13 , 20 ). Its reliability and validity have been confirmed in multiple studies, making it one of the most widely used instruments for assessing end-of-life care attitudes among undergraduate medical students ( 12 , 19 , 21 ). The scale comprises 29 items rated on a five-point Likert scale, with two-thirds of the items addressing attitudes toward caring for dying patients and one-third addressing attitudes toward their families. The instrument includes an equal number of positively and negatively worded statements. Responses range from "strongly disagree" ( 1 ) to "strongly agree" ( 5 ), with reverse scoring applied to negatively worded items. Total scores range from 29 to 145, with higher scores indicating more positive attitudes toward end-of-life care. Empathy levels were measured using the Interpersonal Reactivity Index-Chinese version (IRI-C), originally developed by Davis (1980) ( 22 ) and adapted for the Chinese population by Zhang (2010) ( 23 ). The IRI-C consists of 22 items divided into four subscales: Perspective Taking (PT, 5 items), Fantasy (FS, 6 items), Empathic Concern (EC, 6 items), and Personal Distress (PD, 5 items). Each item is rated on a 5-point Likert scale ranging from 0 (“does not describe me well”) to 4 (“describes me well”), with higher total scores (range: 0–88) reflecting higher levels of empathy. The IRI-C is a validated self-report instrument widely used to assess empathetic tendencies ( 24 ). In the present study, the internal consistency of the FATCOD-B-C and IRI-C was confirmed, with Cronbach’s alpha coefficients of 0.742 and 0.826, respectively, indicating acceptable reliability for both instruments. Statistical analysis Data were analyzed using SPSS version 26.0. And statistical tests were two-side and p -value of < 0.05 was considered statistically significant. Frequencies and proportions were used to describe participants’ general demographic information. Normality of continuous variables was evaluated using the Shapiro–Wilk test prior to conducting parametric or non-parametric analyses. To analyze differences in palliative care attitude scores and empathy scores across demographic groups, independent samples t-tests or one-way ANOVA were applied for normally distributed data, while non-parametric rank-sum tests were used for data that did not meet normality assumptions. Pearson correlation analysis was used to examine the relationship between empathy levels and attitudes toward palliative care, depending on the distribution of the data. Forward selection in multiple linear regression analysis was conducted to identify the main factors influencing empathy levels and attitudes toward palliative care among medical students. Results Participants characteristics Among the 546 medical students who completed the survey, 463 questionnaires were deemed valid and included in the final analysis, including 326 females (70.4%) and 137 males (29.6%) presented in Table 1 . Among the participants, 39.7% reported having participated in hospice palliative care–related internships or training, 40.8% had experienced bereavement, and 25.7% reported previous experience in caring for terminally ill patients and their families. Due to the small sample sizes in specialties such as laboratory medicine, dentistry, medical imaging, rehabilitation, and preventive medicine, these majors were categorized as “Other” (Table 1 ) Table 1 Demographics and Palliative Care Experience of Participants Variables N (%) (N-total = 463) Gender Female 326 (70.4%) Male 137 (29.6%) Academic Years 1st year 69 (14.9%) 2nd year 126 (27.2%) 3rd year 104 (22.5%) 4th year 130 (28.1%) 5th year 34 (7.3%) Age (in years) ≤ 18 27 (5.8%) 19 86 (18.6%) 20 102 (22.0%) 21 112 (24.2%) 22 93 (20.1%) ≥ 23 43 (9.3%) Birthplace Urban 217 (46.9%) Rural 246 (53.1%) Only Child Yes 154 (33.3%) No 309 (66.7%) Religious preference Yes 53 (11.4%) No 410 (88.6%) Medical Specialty Clinical Medicine 229 (49.5%) Nursing 162 (35.0%) Other 72 (15.5%) Volunteer or Part-time Experience Yes 370 (79.9%) No 93 (20.1%) Family Atmosphere Poor 21 (4.5%) Fair 63 (13.6%) Good 229 (49.5%) Very Good 150 (32.4%) Highest Parental Education Level Primary school or below 49 (10.6%) Junior high school 123 (26.6%) Senior high school / Vocational school 131 (28.3%) Associate degree 69 (14.9%) Bachelor’s degree 61 (13.2%) Master’s degree or above 30 (6.5%) Prior education in palliative care Yes 184 (39.7%) No 279 (60.3%) Previous experience with bereavement Yes 189 (40.8%) No 274 (59.2%) Experience of caring for dying patients Yes 119 (25.7%) No 344 (74.3%) Medicine student attitudes toward hospice palliative care and empathy According to the results obtained from the Chinese version of the FATCOD-B scale shown in Table 2 , the total score for medical students’ attitudes toward palliative care ranged from 58 to 133, with a mean of 96.16 ± 10.82. Subscale analyses revealed the following mean scores: 21.03 ± 3.32 for attitude toward the interests of the dying patients (Dimension I); 20.35 ± 3.26 for attitude toward caring for the dying person (Dimension II); 16.66 ± 2.47 for attitude toward the necessity of supporting patients’ families (Dimension III); 14.46 ± 2.99 for attitude toward communication with the dying person (Dimension IV); 14.56 ± 2.71 for attitude toward caring for the dying person’s families (Dimension V); and 9.11 ± 2.33 for attitude toward fear and anxiety when caring for terminal patients (Dimension VI). Table 2 Attitude of the medical students on palliative care Construct Dimensions Mean ± SD I. Attitude toward the interests of the dying person 21.03 ± 3.32 II. Attitude toward caring for the dying person 20.35 ± 3.26 III. Attitude toward the necessity of family support 16.66 ± 2.47 IV. Attitude toward communication with the dying person 14.46 ± 2.99 V. Attitude toward caring for the dying person’s families 14.56 ± 2.71 VI. Attitude toward fear of caring of dying person 9.11 ± 2.33 Sum score 96.16 ± 10.82 SD, standard deviation Subsequently, the IRI-C scale was used to assess the empathy levels of medical students. As shown in Table 3 , the total empathy scores ranged from 19 to 80, with a mean of 52.93 (SD = 11.25). The mean scores for each subscale were as follows: 12.02 (SD = 3.44), 14.63 (SD = 4.02), 14.75 (SD = 3.70); and 11.52 (SD = 3.65) for PT, FS, EC and PD, respectively. Table 3 Empathy score in medical student Construct Dimensions Mean ± SD PT: Perspective Taking 12.02 ± 3.44 FS: Fantasy Scale 14.63 ± 4.02 EC: Empathetic Concern 14.75 ± 3.70 PD: Personal Distress 11.52 ± 3.65 Sum score 52.93 ± 11.25 SD, standard deviation; A high correlation between attitude on palliative care and empathy in medical student We conducted Pearson correlation analysis to investigate the relationship between empathy level and attitudes toward palliative care presented in Table 4 . A significant positive correlation was found between medical students’ overall empathy levels and their attitudes toward palliative care (r = 0.378, p -value < 0.01), suggesting that higher empathy is associated with more favorable attitudes toward end-of-life care. Furthermore, most subdimensions of empathy were also positively correlated with attitudes toward palliative care. Specifically, PT showed a moderate positive correlation (r = 0.227), FS exhibited the strongest correlation (r = 0.416), EC was also significantly correlated (r = 0.380), and PD showed a weaker but still positive association (r = 0.144). Among these, the FS demonstrated the strongest relationship, indicating that greater imaginative ability may be linked to more positive attitudes toward palliative care. Table 4 The correlation between attitude on palliative care with empathy in medical student Sum of IRI-C PT FS EC PD Sum of FATCOD-B 0.378** 0.227** 0.416** 0.380** 0.144** Dimension I 0.254** 0.267** 0.235** 0.201** 0.129** Dimension II 0.243** 0.157** 0.269** 0.299** 0.068 Dimension III 0.329** 0.191** 0.315** 0.334** 0.197** Dimension IV 0.047 -0.063 0.118* 0.038 0.042 Dimension V 0.296** 0.239** 0.293** 0.351** 0.051 Dimension VI 0.187** 0.103* 0.244** 0.188** 0.004 FATCOD-B, The Chinese version of the Frommelt Attitude Toward Care of the Dying Scale Form B; IRI-C, Interpersonal Reactivity Index-Chinese version; Dimension I, Attitude toward the interests of the dying person; Dimension II Attitude toward caring for the dying person; Dimension III, Attitude toward the necessity of family support; Dimension IV, Attitude toward communication with the dying person; Dimension V, Attitude toward caring for the dying person’s families; Dimension VI, Attitude toward fear of caring of dying person; PT, perspective taking; FS, fantasy; EC, empathic concern; PD, personal distress. p -value < 0.05 (*) and < 0.01 (**). Medical student characteristics regulate the attitude on palliative care and empathy To investigate the main factors modifying attitude toward hospice care and empathy levels in medical students, we employed forward selection in multiple linear regression models of participant characteristics on the sum score of FATCOD-B and IRI-C. As Table 5 presented, medical students with better family atmosphere, experience with bereavement or volunteer or part-time job experience have higher score on palliative care and empathy (β > 0 and p -value 0.05, Table 5 ). Interestingly, education experiences on palliative care were positively associated with improved medical students’ attitudes toward dying care, although it did not reach statistical significance (β = 1.47, 95% CI = -0.53 to 3.47 and p -value = 0.149, Table 5 ). Also, FATCOD-B and IRI-C score were negatively associated with parental education level (β < 0), despite of junior high school level was significantly associated with attitude on palliative and master or higher degree with empathy (β < 0, p -values ≤ 0.038, Table 5 ). Additionally, differences in academic majors led to variations in attitudes toward palliative care, but they do not affect the empathy levels of medical students (Table 5 ). Table 5 The association of attitude on palliative care and empathy with characteristics in medical student Variables Sum of FATCOD-B Sum of IRI-C β (95%CI) p -value β (96%CI) p -value Gender Female ref - ref - Male 0.14 (-2.13–2.4) 0.906 0.84 (-1.52–3.2) 0.486 Age (in years) ≤ 18 ref - ref - 19 -0.70 (-3.74–2.34) 0.650 -0.14 (-3.31–3.02) 0.928 20 -1.46 (-5.03–2.11) 0.423 -1.65 (-5.37–2.07) 0.385 21 -2.63 (-6.61–1.35) 0.194 -2.39 (-6.54–1.76) 0.258 22 -1.48 (-5.89–2.93) 0.509 -1.73 (-6.32–2.87) 0.461 ≥ 23 -3.43 (-8.11–1.25) 0.150 -4.62 (-9.50–0.26) 0.063 Only Child No ref - ref - Yes -2.11 (-4.13 - -0.08) 0.041 -2.01 (-4.12–0.09) 0.061 Birthplace Urban ref - ref - Rural 0.53 (-1.35–2.41) 0.580 1.82 (-0.15–3.80) 0.071 Academic Years 1st year ref - ref - 2nd year -0.57 (-3.92–2.78) 0.739 -2.85 (-6.34–0.64) 0.109 3rd year 1.00 (-2.92–4.93) 0.615 0.74 (-3.35–4.83) 0.723 4th year 2.61 (-1.54–6.77) 0.217 3.72 (-0.60–8.05) 0.092 5th year 4.10 (-1.17–9.37) 0.127 3.96 (-1.53–9.45) 0.157 Medical Specialty Other ref - ref - Clinical Medicine -3.23 (-6.10 - -0.37) 0.027 -0.81 (-3.79–2.17) 0.594 Nursing -4.65 (-7.65 - -1.66) 0.002 -1.52 (-4.64–1.60) 0.340 Highest Parental Education Level Primary school or below ref - ref - Junior high school -6.29 (-10.62 - -1.95) 0.005 -1.61 (-6.13–2.91) 0.484 Senior high school / Vocational school -2.72 (-5.84–0.39) 0.087 -0.96 (-4.20–2.29) 0.563 Associate degree 0.57 (-2.81–3.95) 0.740 2.01 (-1.51–5.53) 0.262 Bachelor’s degree -1.31 (-4.32–1.71) 0.396 0.34 (-2.80–3.48) 0.832 Master’s degree or above -3.62 (-7.46–0.21) 0.064 -4.23 (-8.23 - -0.23) 0.038 Family Atmosphere Poor ref - ref - Fair 8.73 (3.79–13.68) 5.73E-4 6.99 (1.83–12.14) 0.008 Good 14.04 (9.42–18.66) 4.85E-9 13.03 (8.22–17.85) 1.64E-7 Very Good 16 (11.36–20.65) 4.05E-11 15.89 (11.05–20.72) 2.91E-10 Previous experience with bereavement No ref - ref - Yes 2.89 (0.99–4.79) 0.003 2.46 (0.48–4.44) 0.015 Prior education in palliative care No ref - ref - Yes 1.47 (-0.53–3.47) 0.149 1.29 (-0.80–3.37) 0.226 Volunteer or Part-time Experience No ref - ref - Yes 4.26 (1.88–6.63) 4.69E-4 3.48 (1.00–5.95) 0.006 Discussion This study investigated the attitudes of medical students toward palliative care, their empathy levels, and the relationship between these two constructs and various influencing factors. The findings revealed that medical students exhibited moderate levels of both empathy and attitudes toward palliative care, with significant variability across individual characteristics. The mean attitude score toward palliative care was 96.16 ± 10.82, consistent with previous findings ( 19 ), but higher than the scores reported in a Chinese multicenter cross-sectional study ( 25 ). In comparison with international studies, levels reported in developed countries were generally higher than those observed here, except in the United Kingdom and Spain, where the results were comparable ( 16 , 17 , 26 , 27 ). One possible explanation is that advance directives are actively promoted by national policies and practices in several countries, including the United States, Canada, the United Kingdom, Spain, Germany, and France ( 28 – 30 ). Although the Chinese government has increased its support for hospice care in recent years, the lack of hospice-related education, combined with the strong influence of the traditional Confucian concept of filial piety, has led many individuals to resist adopting hospice services ( 3 ). Currently, medical education in China continues to emphasize disease treatment over end-of-life care ( 31 ). Palliative care courses are largely offered as electives, with limited coverage and marginal status within the medical curriculum. As a result, medical students often lack systematic knowledge and practical skills related to palliative care ( 5 – 7 ). This situation may be attributed to the relatively late development of hospice care in China, the delayed implementation of death education, and the narrow scope of existing course content, which fails to meet the current practical demands of end-of-life care training ( 3 , 4 ). Regarding empathy, the mean score among medical students was 52.93 ± 11.25, indicating a relatively low level of empathy, lower than the findings reported by Liu Xiuna et al.( 32 ). Moreover, significant heterogeneity in empathy ability has been reported across global nursing student populations ( 33 ). In contrast to global studies, we did not observe significant sex- or birthplace-specific differences in empathy levels in our linear regression analysis. Although several studies have reported a decline in empathy throughout the medical curriculum ( 34 , 35 ), our results showed a slight upward trend in empathy with academic year, although this was not statistically significant. Current medical education tends to overemphasize technical competencies, such as diagnostics and surgical skills, while neglecting communication skills and humanities-oriented courses, leading to a lack of systematic training in empathy development ( 34 , 35 ). This may also be related to differences in humanities curricula across institutions or variability in students’ learning abilities. Therefore, integrating humanities education more effectively and embedding empathy training into clinical courses, like through standardized patient communication exercises, is necessary. A significant positive correlation was identified between empathy and attitudes toward palliative care (r = 0.378, p -value < 0.01), indicating that higher empathy is associated with more positive attitudes toward end-of-life care. Among the empathy subdimensions, Fantasy showed the strongest correlation, suggesting that imaginative capacity may play a key role in shaping attitudes toward caring for dying patients. This finding aligns with previous studies indicating that empathy, especially affective components such as empathic concern and imaginative engagement, enhances healthcare providers’ acceptance and support for palliative care ( 36 – 38 ). Multiple linear regression analysis further showed that a better family atmosphere, prior bereavement experience, and participation in volunteer or part-time work were significant positive predictors of both empathy and attitudes toward palliative care, consistent with previous findings ( 34 ). These results highlight the potential influence of personal life experiences and family environment in fostering empathy and compassionate attitudes among medical students. Educational interventions aiming to enhance empathy and palliative care awareness may benefit from incorporating reflective exercises or exposure to relevant life experiences ( 32 , 39 – 41 ). Academic major was found to influence attitudes toward palliative care but not empathy levels. Students in clinical medicine and nursing reported more positive attitudes than those from other majors, possibly due to curriculum design and clinical exposure in these disciplines, which emphasize patient-centered care and ethical considerations in end-of-life settings ( 5 – 7 ). Notably, although palliative care education was positively associated with attitudes toward palliative care, this did not reach statistical significance ( p -value = 0.149), suggesting that current educational interventions may be insufficient to produce measurable attitude changes, or that the effect size is small within this population. Future research should explore more intensive, experiential, or longitudinal palliative care education to achieve greater impact ( 14 , 15 ). Unexpectedly, parental education level was negatively associated with empathy and attitudes toward palliative care, with significant associations observed for certain education levels. This counterintuitive finding may be explained by sociocultural factors or varying family dynamics, warranting further investigation into how family background shapes the development of empathy and attitudes toward end-of-life care. Conclusion Overall, this study underscores the complex interplay between personal characteristics, empathy, and attitudes toward palliative care among medical students. Targeted educational strategies, combined with opportunities for experiential learning, may be valuable in cultivating compassionate care attitudes and empathy, ultimately enhancing future physicians’ readiness to provide quality end-of-life care. Abbreviations FATCOD-B Frommelt Attitude Toward Care of the Dying Scale Form B IRI-C Interpersonal Reactivity Index-Chinese version PT Perspective taking FS Fantasy EC Empathic concern PD Personal distress SD standard deviation Declarations Ethics approval and consent to participate The study was performed according to the Helsinki Declaration and was approved by the Ethics Committee of the First Affiliated Hospital of Shihezi University (reference number: AF/SC-08/01.0). In order to maintain confidentiality, participants' information was anonymized, and pseudonyms were used. Written informed consent was obtained from participants in this study. Consent for publication Not applicable. Funding This work was supported by the Shihezi University Research Fund (No. ZZZC2022083) under the project titled "Construction and Empirical Study of a Hospice Care Model for Terminal Cancer Patients Based on Swanson's Theory of Caring". It was also supported by the Scientific Research Program of the Chinese Nursing Association (Project No. ZHKYQ202404), entitled "Research on a Decision-Making System for Home-Based Cancer Pain Patients Based on User Portrait". Authors’ contribution Yan Wang and Cengceng Lu designed the study. Cengceng Lu, Jing Li, Huan Chen, Min Ding and Yue Zhao collected the data. Cengceng Lu and Huan Chen analyzed the data and Cengceng Lu wrote the manuscript. Min Ding and Yan Wang revised the manuscript. All authors contributed to the article and approved the submitted version. Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Data availability The datasets generated for this study are available on request to the corresponding author. References Wajid M, Rajkumar E, Romate J, George AJ, Lakshmi R, Simha S. Why is hospice care important? 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Palliative care in Mozambique: Physicians' knowledge, attitudes and practices. PLoS ONE. 2020;15(8):e0238023. Davis MH. A multidimensional approach to individual differences in empathy. 1980. Zhang F-f, Dong Y, Wang K. Reliability and validity of the Chinese version of the Interpersonal Reactivity Index-C. Chin J Clin Psychol. 2010. Chen P, Wang G, Ma R, Jing F, Zhang Y, Wang Y, et al. Multidimensional assessment of empathic abilities in patients with insular glioma. Cogn Affect Behav Neurosci. 2016;16:962–75. Xue B, Cheng Q, Yue SW, Zhao ZH, Wang R, Redding SR, et al. Attitudes and knowledge of palliative care of Chinese undergraduate nursing students: A multicenter cross-sectional study. Nurse Educ Today. 2023;122:105720. Ferri P, Di Lorenzo R, Stifani S, Morotti E, Vagnini M, Jimenez Herrera MF, et al. Nursing student attitudes toward dying patient care: A European multicenter cross-sectional study. Acta Biomed. 2021;92(S2):e2021018. Younis WY, Hamdan-Mansour AM. Status and predictors of medical students' knowledge and attitude towards palliative care in Jordan: a cross-sectional study. BMC Palliat Care. 2024;23(1):9. Fried TR, Drickamer M. Garnering support for advance care planning. JAMA. 2010;303(3):269–70. Choudhry NK, Ma J, Rasooly I, Singer PA. Long-term care facility policies on life-sustaining treatments and advance directives in Canada. J Am Geriatr Soc. 1994;42(11):1150–3. Veshi D, Neitzke G. Advance Directives in Some Western European Countries: A Legal and Ethical Comparison between Spain, France, England, and Germany. Eur J Health Law. 2015;22(4):321–45. Huang X, Qin X, Luo Z, Li L, Hu J. Tuberculous choroiditis masquerading as sympathetic ophthalmia: a case report. Intractable Rare Dis Res. 2020;9(3):171–4. LIU X-n JIANGY. ZHU M-x. Research on Characteristic of Empathy for Undergraduate Nursing Students. Chin J Mod Nurs. 2010;16(19):2244–6. Jia-Ru J, Yan-Xue Z, Wen-Nv H. Empathy ability of nursing students: A systematic review and meta-analysis. Med (Baltim). 2022;101(32):e30017. Lertsakulbunlue S, Kiatsrithanakorn C, Kittisarapong P, Thammasoon K, Puengpreeda S, Bhuriveth V, et al. Declining empathy trends throughout medical curriculum and association factors of low empathy among medical students and residents: a single center study. BMC Med Educ. 2024;24(1):951. Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Does Empathy Decline in the Clinical Phase of Medical Education? A Nationwide, Multi-Institutional, Cross-Sectional Study of Students at DO-Granting Medical Schools. Acad Med. 2020;95(6):911–8. Ruiz-Junco N, Morrison DR. Empathy as Care: the Model of Palliative Medicine. Society. 2019;56(2):158–65. Wang YL, Yang ZW, Tang YZ, Li HL, Zhou LS. A qualitative exploration of empathic labor in Chinese hospice nurses. BMC Palliat Care. 2022;21(1):23. Ford J, Hepburn A, Parry R. What do displays of empathy do in palliative care consultations? Discourse Stud. 2019;21(1):22–37. Yao G-Y, Luo Y-Y, Zhao Z-M, Zhu B, Gao M. The Moderating Role of Empathy Profiles in the Relationship Between Knowledge about Aging and Attitudes Toward Older Adults among Nursing Students. Front Psychol. 2021;12. Liu F, Zhou H, Yuan L, Cai Y. Effect of empathy competence on moral sensitivity in Chinese student nurses: the mediating role of emotional intelligence. BMC Nurs. 2023;22(1):483. Wang Z, Liang Y, Zhao H, Zhu Y, Liu M, Zhang Y, et al. Spiritual care perceptions and empathy of Chinese nursing students: The mediating roles of spiritual well-being. Palliat Support Care. 2022;20(5):701–10. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6614595","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":467269196,"identity":"7db36152-c20f-425b-a914-37b10bfc2714","order_by":0,"name":"Cengceng Lu","email":"","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Cengceng","middleName":"","lastName":"Lu","suffix":""},{"id":467269197,"identity":"3cd8302a-bd51-4104-acf6-09de02d27c48","order_by":1,"name":"Jing Li","email":"","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Li","suffix":""},{"id":467269198,"identity":"20170157-d29b-40ba-b334-487e73e0b6ae","order_by":2,"name":"Huan Chen","email":"","orcid":"","institution":"Health Insurance Administration Office, Zhe Jiang University Sir Run Run Shaw Alaer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Chen","suffix":""},{"id":467269199,"identity":"90fbdf87-07b0-4e75-8c3a-d524ab1c3766","order_by":3,"name":"Yue Zhao","email":"","orcid":"","institution":"Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Zhao","suffix":""},{"id":467269200,"identity":"890959f6-23da-42bc-a5e1-131254d5fdd2","order_by":4,"name":"Min Ding","email":"","orcid":"","institution":"People's Hospital of Xinjiang Uygur Autonomous Region","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Ding","suffix":""},{"id":467269201,"identity":"b7fad92e-a14e-4e58-9d5b-aa3ea5cd9eb3","order_by":5,"name":"Yan Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACNvbGxsd//0jIMbY3HyBOCx/P4WYD3gYbY+aeYwnEaZGTSG8T4G1IS2yfkWNApMMYEtsYJHccZuydkfPxxhsGOzndBoJaDrY9MDxzmFmy5+1myzkMycZmBwhpYWxsN0hgO8xm2J67TZqH4UDiNoJamBnbJA6wHeaxP5DzjEgtbIxtko1taRKMHTlsRGrhYWw2ZjhjY8DYc8zYco4BEX6Rn//84WOGCon6xvbmhzfeVNjJEdSCAiR4iIwaZC2k6hgFo2AUjIIRAQBsJkQWmZSK4gAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":true,"prefix":"","firstName":"Yan","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-05-07 19:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6614595/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6614595/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84087347,"identity":"d26a8c13-16d5-492e-8851-7646140e9cd0","added_by":"auto","created_at":"2025-06-06 15:19:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":972400,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6614595/v1/feb0097e-541e-4a09-8930-2bb2458e78a7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Empathy and Attitudes Toward Palliative Care Among Chinese Medical Students: A Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003ePalliative care, which focuses on improving the quality of life for patients with life-threatening illnesses and supporting their families, has become an increasingly vital component of healthcare worldwide. Importantly, this approach extends its support not only to patients but also to their families, both during the patient\u0026rsquo;s life and after their death(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). \u003cem\u003eThe Lancet Global Health\u003c/em\u003e projects that by 2060, approximately 48\u0026nbsp;million people - representing 47% of all global deaths - will die while experiencing serious health-related suffering, reflecting an 87% increase from 26\u0026nbsp;million cases in 2016. Notably, 83% of these deaths will occur in low- and middle-income countries, with the most pronounced rise expected in low-income countries, where the burden is projected to increase by 155% between 2016 and 2060 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite these global trends, palliative care education in China has lagged behind, often marginalized within medical curricula and typically offered as elective rather than core coursework (\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Combined with the influence of traditional cultural values, such as filial piety, and a societal reluctance to discuss death openly, the development and acceptance of hospice and palliative care in China face considerable challenges.\u003c/p\u003e \u003cp\u003eEmpathy is a multidimensional construct comprising both cognitive and affective components. It is defined as the ability to adopt and understand another person\u0026rsquo;s perspective, share in their emotional experiences, and convey warmth and acceptance. Cognitive empathy refers to an individual\u0026rsquo;s capacity to recognize another person\u0026rsquo;s condition and infer their thoughts, perspectives, and emotions from a psychological standpoint, while affective empathy involves emotional responsiveness and concern for the feelings and well-being of others (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Medical students, as future healthcare providers, play a pivotal role in shaping the future landscape of palliative care services. Their attitudes toward palliative care and their empathy levels are crucial factors that influence their willingness and ability to deliver compassionate, patient-centered end-of-life care (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Although previous studies have examined these aspects in other countries (\u003cspan additionalcitationids=\"CR13 CR14 CR15 CR16\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), there is limited research focused specifically on Chinese medical students, particularly regarding how their personal characteristics, educational experiences, and empathy levels interact to shape their attitudes toward palliative care.\u003c/p\u003e \u003cp\u003eThis study aims to assess the attitudes of Chinese medical students toward palliative care, measure their empathy levels, and explore the relationship between these two constructs. In addition, the study investigates how individual characteristics - including demographic factors, personal experiences, and academic background - influence these outcomes, with the goal of providing evidence-based recommendations for improving palliative care education and training in China.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and sample\u003c/h2\u003e \u003cp\u003eThis study employed a convenience sampling method. From January to March 2024, undergraduate students majoring in clinical medicine, nursing, and related disciplines from first to fourth/fifth year at a medical college in Shihezi were recruited. Inclusion criteria were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) full-time undergraduate medical students admitted through the National College Entrance Examination who were currently enrolled in the first to fourth/fifth year of a medical program; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) individuals without psychiatric or cognitive disorders and capable of understanding the questionnaire content; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) students who provided informed consent and voluntarily agreed to participate. Exclusion criteria included: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) students diagnosed with psychiatric or psychological disorders; and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) those enrolled in non-medical majors, or who had suspended their studies, dropped out, or joined the military during their academic program.\u003c/p\u003e \u003cp\u003eThe study included a total of 65 independent variables, comprising 14 items related to general demographic information, 29 items assessing attitudes toward palliative care, and 22 items measuring empathy levels. According to the general rule of thumb that the sample size should be 5 to 10 times the number of parameters to be estimated (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), the required sample size was estimated to range between 325 and 650 participants. To accommodate potential issues such as low-quality responses and sample attrition, and to ensure an adequate number of valid questionnaires for statistical analysis, the final sample size was determined by multiplying the number of variables by 7 and adding an additional 20%. As a result, the target sample size was set at 546 participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003e Ethical approval\u003c/strong\u003e was obtained from the Ethics Committee of the First Affiliated Hospital of Shihezi University prior to data collection. The university subsequently facilitated access to medical students by coordinating communication efforts. The role of university facilitators was limited to announcing the study and its purpose via student boards and social media groups. A standardized instruction was used to explain the purpose of the study and the guidelines for completing the questionnaire to all participants, and informed consent was obtained prior to participation. Interested students were invited to contact the researcher, who explained the study's purpose and significance, and emphasized that participation was entirely voluntary. Participants were assured that refusal to participate would not affect their academic status in any way. The researcher also addressed issues of anonymity, privacy, and confidentiality, and informed students of their right to withdraw from the study at any time.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe questionnaire was distributed and collected via the online platform \"Questionnaire Star\" (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.wjx.cn\" target=\"_blank\"\u003ewww.wjx.cn\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.wjx.cn\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). A total of 546 questionnaires were distributed, of which 463 were valid, yielding an effective response rate of 84.8%. Digital data were stored on a password-protected computer.\u003c/p\u003e\n\u003ch3\u003eMeasurement instruments\u003c/h3\u003e\n\u003cp\u003eA self-designed general information questionnaire was employed to assess the participants general characteristic, including gender, year of study, major, only child status, place of origin, age, internships or training experience with hospice palliative care, participation in volunteer service, family atmosphere, highest parental education level, religious affiliation, experience of bereavement, and previous experience in caring for terminally ill patients and their families.\u003c/p\u003e \u003cp\u003eThe Chinese version of the Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B) was employed to assess medical students\u0026rsquo; attitudes toward caring for dying patients. This instrument has demonstrated good construct validity, concurrent validity, convergent validity, and internal consistency in previous studies (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The FATCOD is one of the few psychometric tools specifically designed to measure attitudes toward end-of-life care among healthcare students (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Its reliability and validity have been confirmed in multiple studies, making it one of the most widely used instruments for assessing end-of-life care attitudes among undergraduate medical students (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The scale comprises 29 items rated on a five-point Likert scale, with two-thirds of the items addressing attitudes toward caring for dying patients and one-third addressing attitudes toward their families. The instrument includes an equal number of positively and negatively worded statements. Responses range from \"strongly disagree\" (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) to \"strongly agree\" (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), with reverse scoring applied to negatively worded items. Total scores range from 29 to 145, with higher scores indicating more positive attitudes toward end-of-life care.\u003c/p\u003e \u003cp\u003eEmpathy levels were measured using the Interpersonal Reactivity Index-Chinese version (IRI-C), originally developed by Davis (1980) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and adapted for the Chinese population by Zhang (2010) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The IRI-C consists of 22 items divided into four subscales: \u003cem\u003ePerspective Taking\u003c/em\u003e (PT, 5 items), \u003cem\u003eFantasy\u003c/em\u003e (FS, 6 items), \u003cem\u003eEmpathic Concern\u003c/em\u003e (EC, 6 items), and \u003cem\u003ePersonal Distress\u003c/em\u003e (PD, 5 items). Each item is rated on a 5-point Likert scale ranging from 0 (\u0026ldquo;does not describe me well\u0026rdquo;) to 4 (\u0026ldquo;describes me well\u0026rdquo;), with higher total scores (range: 0\u0026ndash;88) reflecting higher levels of empathy. The IRI-C is a validated self-report instrument widely used to assess empathetic tendencies (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present study, the internal consistency of the FATCOD-B-C and IRI-C was confirmed, with Cronbach\u0026rsquo;s alpha coefficients of 0.742 and 0.826, respectively, indicating acceptable reliability for both instruments.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS version 26.0. And statistical tests were two-side and \u003cem\u003ep\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. Frequencies and proportions were used to describe participants\u0026rsquo; general demographic information. Normality of continuous variables was evaluated using the Shapiro\u0026ndash;Wilk test prior to conducting parametric or non-parametric analyses. To analyze differences in palliative care attitude scores and empathy scores across demographic groups, independent samples t-tests or one-way ANOVA were applied for normally distributed data, while non-parametric rank-sum tests were used for data that did not meet normality assumptions. Pearson correlation analysis was used to examine the relationship between empathy levels and attitudes toward palliative care, depending on the distribution of the data. Forward selection in multiple linear regression analysis was conducted to identify the main factors influencing empathy levels and attitudes toward palliative care among medical students.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipants characteristics\u003c/h2\u003e \u003cp\u003eAmong the 546 medical students who completed the survey, 463 questionnaires were deemed valid and included in the final analysis, including 326 females (70.4%) and 137 males (29.6%) presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Among the participants, 39.7% reported having participated in hospice palliative care\u0026ndash;related internships or training, 40.8% had experienced bereavement, and 25.7% reported previous experience in caring for terminally ill patients and their families. Due to the small sample sizes in specialties such as laboratory medicine, dentistry, medical imaging, rehabilitation, and preventive medicine, these majors were categorized as \u0026ldquo;Other\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and Palliative Care Experience of Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%) (N-total\u0026thinsp;=\u0026thinsp;463)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e326 (70.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e137 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (14.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e130 (28.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (in years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102 (22.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93 (20.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthplace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e217 (46.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e246 (53.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly Child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e154 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e309 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious preference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e410 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical Specialty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229 (49.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e162 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVolunteer or Part-time Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e370 (79.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93 (20.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Atmosphere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229 (49.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery Good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e150 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest Parental Education Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123 (26.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior high school / Vocational school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e131 (28.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (14.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61 (13.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u0026rsquo;s degree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior education in palliative care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e279 (60.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious experience with bereavement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189 (40.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e274 (59.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperience of caring for dying patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e344 (74.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMedicine student attitudes toward hospice palliative care and empathy\u003c/h3\u003e\n\u003cp\u003eAccording to the results obtained from the Chinese version of the FATCOD-B scale shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the total score for medical students\u0026rsquo; attitudes toward palliative care ranged from 58 to 133, with a mean of 96.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82. Subscale analyses revealed the following mean scores: 21.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32 for \u003cem\u003eattitude toward the interests of the dying patients\u003c/em\u003e (Dimension I); 20.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26 for \u003cem\u003eattitude toward caring for the dying person\u003c/em\u003e (Dimension II); 16.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47 for \u003cem\u003eattitude toward the necessity of supporting patients\u0026rsquo; families\u003c/em\u003e (Dimension III); 14.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99 for \u003cem\u003eattitude toward communication with the dying person\u003c/em\u003e (Dimension IV); 14.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71 for \u003cem\u003eattitude toward caring for the dying person\u0026rsquo;s families\u003c/em\u003e (Dimension V); and 9.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33 for \u003cem\u003eattitude toward fear and anxiety when caring for terminal patients\u003c/em\u003e (Dimension VI).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAttitude of the medical students on palliative care\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstruct Dimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI. Attitude toward the interests of the dying person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII. Attitude toward caring for the dying person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII. Attitude toward the necessity of family support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV. Attitude toward communication with the dying person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV. Attitude toward caring for the dying person\u0026rsquo;s families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVI. Attitude toward fear of caring of dying person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSum score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSD, standard deviation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSubsequently, the IRI-C scale was used to assess the empathy levels of medical students. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the total empathy scores ranged from 19 to 80, with a mean of 52.93 (SD\u0026thinsp;=\u0026thinsp;11.25). The mean scores for each subscale were as follows: 12.02 (SD\u0026thinsp;=\u0026thinsp;3.44), 14.63 (SD\u0026thinsp;=\u0026thinsp;4.02), 14.75 (SD\u0026thinsp;=\u0026thinsp;3.70); and 11.52 (SD\u0026thinsp;=\u0026thinsp;3.65) for PT, FS, EC and PD, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEmpathy score in medical student\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstruct Dimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT: Perspective Taking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFS: Fantasy Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEC: Empathetic Concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePD: Personal Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSum score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.93\u0026thinsp;\u0026plusmn;\u0026thinsp;11.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSD, standard deviation;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eA high correlation between attitude on palliative care and empathy in medical student\u003c/h3\u003e\n\u003cp\u003eWe conducted Pearson correlation analysis to investigate the relationship between empathy level and attitudes toward palliative care presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. A significant positive correlation was found between medical students\u0026rsquo; overall empathy levels and their attitudes toward palliative care (r\u0026thinsp;=\u0026thinsp;0.378, \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01), suggesting that higher empathy is associated with more favorable attitudes toward end-of-life care. Furthermore, most subdimensions of empathy were also positively correlated with attitudes toward palliative care. Specifically, PT showed a moderate positive correlation (r\u0026thinsp;=\u0026thinsp;0.227), FS exhibited the strongest correlation (r\u0026thinsp;=\u0026thinsp;0.416), EC was also significantly correlated (r\u0026thinsp;=\u0026thinsp;0.380), and PD showed a weaker but still positive association (r\u0026thinsp;=\u0026thinsp;0.144). Among these, the FS demonstrated the strongest relationship, indicating that greater imaginative ability may be linked to more positive attitudes toward palliative care.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe correlation between attitude on palliative care with empathy in medical student\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSum of IRI-C\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSum of FATCOD-B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.378**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.227**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.416**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.380**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.144**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.254**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.267**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.235**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.201**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.129**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.243**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.157**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.269**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.299**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.329**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.191**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.315**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.334**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.197**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.118*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.296**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.239**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.293**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.351**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.187**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.103*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.244**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.188**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eFATCOD-B, The Chinese version of the Frommelt Attitude Toward Care of the Dying Scale Form B; IRI-C, Interpersonal Reactivity Index-Chinese version; Dimension I, Attitude toward the interests of the dying person; Dimension II Attitude toward caring for the dying person; Dimension III, Attitude toward the necessity of family support; Dimension IV, Attitude toward communication with the dying person; Dimension V, Attitude toward caring for the dying person\u0026rsquo;s families; Dimension VI, Attitude toward fear of caring of dying person; PT, perspective taking; FS, fantasy; EC, empathic concern; PD, personal distress. \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (*) and \u0026lt;\u0026thinsp;0.01 (**).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMedical student characteristics regulate the attitude on palliative care and empathy\u003c/h2\u003e \u003cp\u003eTo investigate the main factors modifying attitude toward hospice care and empathy levels in medical students, we employed forward selection in multiple linear regression models of participant characteristics on the sum score of FATCOD-B and IRI-C. As Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presented, medical students with better family atmosphere, experience with bereavement or volunteer or part-time job experience have higher score on palliative care and empathy (β\u0026thinsp;\u0026gt;\u0026thinsp;0 and \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, we did not observe any significant association of FATCOD-B and IRI-C with sex, age, academic years (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Interestingly, education experiences on palliative care were positively associated with improved medical students\u0026rsquo; attitudes toward dying care, although it did not reach statistical significance (β\u0026thinsp;=\u0026thinsp;1.47, 95% CI = -0.53 to 3.47 and \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.149, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Also, FATCOD-B and IRI-C score were negatively associated with parental education level (β\u0026thinsp;\u0026lt;\u0026thinsp;0), despite of junior high school level was significantly associated with attitude on palliative and master or higher degree with empathy (β\u0026thinsp;\u0026lt;\u0026thinsp;0, \u003cem\u003ep\u003c/em\u003e-values\u0026thinsp;\u0026le;\u0026thinsp;0.038, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Additionally, differences in academic majors led to variations in attitudes toward palliative care, but they do not affect the empathy levels of medical students (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe association of attitude on palliative care and empathy with characteristics in medical student\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSum of FATCOD-B\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSum of IRI-C\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ (96%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14 (-2.13\u0026ndash;2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84 (-1.52\u0026ndash;3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (in years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.70 (-3.74\u0026ndash;2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.14 (-3.31\u0026ndash;3.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.928\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.46 (-5.03\u0026ndash;2.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.65 (-5.37\u0026ndash;2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.63 (-6.61\u0026ndash;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.39 (-6.54\u0026ndash;1.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.48 (-5.89\u0026ndash;2.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.73 (-6.32\u0026ndash;2.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.461\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.43 (-8.11\u0026ndash;1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.62 (-9.50\u0026ndash;0.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly Child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.11 (-4.13 - -0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.01 (-4.12\u0026ndash;0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirthplace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.53 (-1.35\u0026ndash;2.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.82 (-0.15\u0026ndash;3.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic Years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.57 (-3.92\u0026ndash;2.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.85 (-6.34\u0026ndash;0.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (-2.92\u0026ndash;4.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.74 (-3.35\u0026ndash;4.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.61 (-1.54\u0026ndash;6.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.72 (-0.60\u0026ndash;8.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.10 (-1.17\u0026ndash;9.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.96 (-1.53\u0026ndash;9.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical Specialty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.23 (-6.10 - -0.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.81 (-3.79\u0026ndash;2.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.65 (-7.65 - -1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.52 (-4.64\u0026ndash;1.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest Parental Education Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-6.29 (-10.62 - -1.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.61 (-6.13\u0026ndash;2.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior high school / Vocational school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.72 (-5.84\u0026ndash;0.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.96 (-4.20\u0026ndash;2.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.57 (-2.81\u0026ndash;3.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.01 (-1.51\u0026ndash;5.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.31 (-4.32\u0026ndash;1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34 (-2.80\u0026ndash;3.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.832\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u0026rsquo;s degree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.62 (-7.46\u0026ndash;0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.23 (-8.23 - -0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Atmosphere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.73 (3.79\u0026ndash;13.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.73E-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.99 (1.83\u0026ndash;12.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.04 (9.42\u0026ndash;18.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.85E-9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.03 (8.22\u0026ndash;17.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.64E-7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery Good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (11.36\u0026ndash;20.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.05E-11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.89 (11.05\u0026ndash;20.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.91E-10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious experience with bereavement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.89 (0.99\u0026ndash;4.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.46 (0.48\u0026ndash;4.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior education in palliative care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.47 (-0.53\u0026ndash;3.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.29 (-0.80\u0026ndash;3.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVolunteer or Part-time Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.26 (1.88\u0026ndash;6.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.69E-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.48 (1.00\u0026ndash;5.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the attitudes of medical students toward palliative care, their empathy levels, and the relationship between these two constructs and various influencing factors. The findings revealed that medical students exhibited moderate levels of both empathy and attitudes toward palliative care, with significant variability across individual characteristics.\u003c/p\u003e \u003cp\u003eThe mean attitude score toward palliative care was 96.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82, consistent with previous findings (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), but higher than the scores reported in a Chinese multicenter cross-sectional study (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In comparison with international studies, levels reported in developed countries were generally higher than those observed here, except in the United Kingdom and Spain, where the results were comparable (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). One possible explanation is that advance directives are actively promoted by national policies and practices in several countries, including the United States, Canada, the United Kingdom, Spain, Germany, and France (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Although the Chinese government has increased its support for hospice care in recent years, the lack of hospice-related education, combined with the strong influence of the traditional Confucian concept of filial piety, has led many individuals to resist adopting hospice services (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Currently, medical education in China continues to emphasize disease treatment over end-of-life care (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Palliative care courses are largely offered as electives, with limited coverage and marginal status within the medical curriculum. As a result, medical students often lack systematic knowledge and practical skills related to palliative care (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This situation may be attributed to the relatively late development of hospice care in China, the delayed implementation of death education, and the narrow scope of existing course content, which fails to meet the current practical demands of end-of-life care training (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding empathy, the mean score among medical students was 52.93\u0026thinsp;\u0026plusmn;\u0026thinsp;11.25, indicating a relatively low level of empathy, lower than the findings reported by Liu Xiuna et al.(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Moreover, significant heterogeneity in empathy ability has been reported across global nursing student populations (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In contrast to global studies, we did not observe significant sex- or birthplace-specific differences in empathy levels in our linear regression analysis. Although several studies have reported a decline in empathy throughout the medical curriculum (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), our results showed a slight upward trend in empathy with academic year, although this was not statistically significant. Current medical education tends to overemphasize technical competencies, such as diagnostics and surgical skills, while neglecting communication skills and humanities-oriented courses, leading to a lack of systematic training in empathy development (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). This may also be related to differences in humanities curricula across institutions or variability in students\u0026rsquo; learning abilities. Therefore, integrating humanities education more effectively and embedding empathy training into clinical courses, like through standardized patient communication exercises, is necessary.\u003c/p\u003e \u003cp\u003eA significant positive correlation was identified between empathy and attitudes toward palliative care (r\u0026thinsp;=\u0026thinsp;0.378, \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating that higher empathy is associated with more positive attitudes toward end-of-life care. Among the empathy subdimensions, Fantasy showed the strongest correlation, suggesting that imaginative capacity may play a key role in shaping attitudes toward caring for dying patients. This finding aligns with previous studies indicating that empathy, especially affective components such as empathic concern and imaginative engagement, enhances healthcare providers\u0026rsquo; acceptance and support for palliative care (\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Multiple linear regression analysis further showed that a better family atmosphere, prior bereavement experience, and participation in volunteer or part-time work were significant positive predictors of both empathy and attitudes toward palliative care, consistent with previous findings (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). These results highlight the potential influence of personal life experiences and family environment in fostering empathy and compassionate attitudes among medical students. Educational interventions aiming to enhance empathy and palliative care awareness may benefit from incorporating reflective exercises or exposure to relevant life experiences (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAcademic major was found to influence attitudes toward palliative care but not empathy levels. Students in clinical medicine and nursing reported more positive attitudes than those from other majors, possibly due to curriculum design and clinical exposure in these disciplines, which emphasize patient-centered care and ethical considerations in end-of-life settings (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Notably, although palliative care education was positively associated with attitudes toward palliative care, this did not reach statistical significance (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.149), suggesting that current educational interventions may be insufficient to produce measurable attitude changes, or that the effect size is small within this population. Future research should explore more intensive, experiential, or longitudinal palliative care education to achieve greater impact (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Unexpectedly, parental education level was negatively associated with empathy and attitudes toward palliative care, with significant associations observed for certain education levels. This counterintuitive finding may be explained by sociocultural factors or varying family dynamics, warranting further investigation into how family background shapes the development of empathy and attitudes toward end-of-life care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall, this study underscores the complex interplay between personal characteristics, empathy, and attitudes toward palliative care among medical students. Targeted educational strategies, combined with opportunities for experiential learning, may be valuable in cultivating compassionate care attitudes and empathy, ultimately enhancing future physicians\u0026rsquo; readiness to provide quality end-of-life care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFATCOD-B\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Frommelt Attitude Toward Care of the Dying Scale Form B\u003c/p\u003e\n\u003cp\u003eIRI-C \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Interpersonal Reactivity Index-Chinese version\u003c/p\u003e\n\u003cp\u003ePT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Perspective taking\u003c/p\u003e\n\u003cp\u003eFS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Fantasy\u003c/p\u003e\n\u003cp\u003eEC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Empathic concern\u003c/p\u003e\n\u003cp\u003ePD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Personal distress\u003c/p\u003e\n\u003cp\u003eSD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; standard deviation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was performed according to the Helsinki Declaration and was approved by the Ethics Committee of the First Affiliated Hospital of Shihezi University (reference number: AF/SC-08/01.0). In order to maintain confidentiality, participants\u0026apos; information was anonymized, and pseudonyms were used. Written informed consent was obtained from participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Shihezi University Research Fund (No. ZZZC2022083) under the project titled \u0026quot;Construction and Empirical Study of a Hospice Care Model for Terminal Cancer Patients Based on Swanson\u0026apos;s Theory of Caring\u0026quot;. It was also supported by the Scientific Research Program of the Chinese Nursing Association (Project No. ZHKYQ202404), entitled \u0026quot;Research on a Decision-Making System for Home-Based Cancer Pain Patients Based on User Portrait\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYan Wang and Cengceng Lu designed the study. Cengceng Lu, Jing Li, Huan Chen, Min Ding and Yue Zhao collected the data. Cengceng Lu and Huan Chen analyzed the data and Cengceng Lu wrote the manuscript. Min Ding and Yan Wang revised the manuscript. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated for this study are available on request to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWajid M, Rajkumar E, Romate J, George AJ, Lakshmi R, Simha S. Why is hospice care important? An exploration of its benefits for patients with terminal cancer. BMC Palliat Care. 2021;20(1):70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSleeman KE, de Brito M, Etkind S, Nkhoma K, Guo P, Higginson IJ, et al. 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BMC Med Educ. 2024;24(1):951.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Does Empathy Decline in the Clinical Phase of Medical Education? A Nationwide, Multi-Institutional, Cross-Sectional Study of Students at DO-Granting Medical Schools. Acad Med. 2020;95(6):911\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuiz-Junco N, Morrison DR. Empathy as Care: the Model of Palliative Medicine. Society. 2019;56(2):158\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang YL, Yang ZW, Tang YZ, Li HL, Zhou LS. A qualitative exploration of empathic labor in Chinese hospice nurses. BMC Palliat Care. 2022;21(1):23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFord J, Hepburn A, Parry R. What do displays of empathy do in palliative care consultations? Discourse Stud. 2019;21(1):22\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYao G-Y, Luo Y-Y, Zhao Z-M, Zhu B, Gao M. The Moderating Role of Empathy Profiles in the Relationship Between Knowledge about Aging and Attitudes Toward Older Adults among Nursing Students. Front Psychol. 2021;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu F, Zhou H, Yuan L, Cai Y. Effect of empathy competence on moral sensitivity in Chinese student nurses: the mediating role of emotional intelligence. BMC Nurs. 2023;22(1):483.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Z, Liang Y, Zhao H, Zhu Y, Liu M, Zhang Y, et al. Spiritual care perceptions and empathy of Chinese nursing students: The mediating roles of spiritual well-being. Palliat Support Care. 2022;20(5):701\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hospice Palliative Care, Attitude, Dying patients, Empathy, Undergraduate, Medical Students","lastPublishedDoi":"10.21203/rs.3.rs-6614595/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6614595/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePalliative care is increasingly recognized worldwide for improving the quality of life of patients with life-threatening illnesses and their families. However, in China, palliative care education is often marginalized, and limited research has examined how medical students\u0026rsquo; empathy levels and personal characteristics influence their attitudes toward palliative care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study surveyed 546 undergraduate students from clinical medicine, nursing, and related majors at a Chinese medical university, with 463 valid responses analyzed (response rate: 84.8%). Data were collected using an online questionnaire incorporating demographic measures, the Chinese version of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD-B), and the Interpersonal Reactivity Index-Chinese version (IRI-C). Statistical analyses included descriptive statistics, Pearson correlation, and multiple linear regression.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eThe mean attitude score toward palliative care was 96.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.82, and the mean empathy score was 52.93\u0026thinsp;\u0026plusmn;\u0026thinsp;11.25, indicating moderate levels. Empathy was significantly positively correlated with attitudes toward palliative care (r\u0026thinsp;=\u0026thinsp;0.378, \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with the Fantasy subdimension showing the strongest association. Regression analysis identified better family atmosphere, bereavement experience, and volunteer or part-time work as significant predictors of both empathy and attitudes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIntegrating empathy training and experiential learning into medical curricula may enhance Chinese medical students\u0026rsquo; preparedness to deliver compassionate end-of-life care, highlighting the need for targeted palliative care education reforms.\u003c/p\u003e","manuscriptTitle":"Empathy and Attitudes Toward Palliative Care Among Chinese Medical Students: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-06 15:03:42","doi":"10.21203/rs.3.rs-6614595/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-14T14:21:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-03T08:47:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"248115219529629154768471669820804883078","date":"2025-06-23T00:12:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-19T13:24:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151783519667131789605841717945880747111","date":"2025-06-19T13:12:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-06T01:23:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204478482217701538935412074629750082828","date":"2025-06-05T05:32:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-04T13:14:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-02T12:34:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-09T10:00:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-09T09:22:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2025-05-09T09:21:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f84d42e9-159e-4d1d-9c85-3327c1c04490","owner":[],"postedDate":"June 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T14:23:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-06 15:03:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6614595","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6614595","identity":"rs-6614595","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}