Self-efficacy of oncology nurses in palliative-care: an Analysis of the current status and influencing factors

Self-efficacy of oncology nurses in palliative-care: an Analysis of the current status and influencing factors | 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 Self-efficacy of oncology nurses in palliative-care: an Analysis of the current status and influencing factors Meiling Lu, Shuang Yang, Simiao Yu, Zhang Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9194676/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective This study aimed to evaluate the current status of palliative care self-efficacy, palliative care knowledge, and self-reported hospice care practices among oncology nurses. In addition, it sought to identify the factors influencing palliative care self-efficacy and to provide a theoretical foundation for developing effective palliative care management strategies for oncology nursing. Methods A cross-sectional survey was conducted among 381 oncology nurses recruited through convenience sampling from 22 hospitals in Tianjin, China, between February and April 2025. Data were collected using a general information questionnaire, the Palliative Care Self-Efficacy Scale, the Palliative Care Knowledge Quiz, and the Palliative Care Self-Reported Practices Scale. Results The mean palliative care self-efficacy score among oncology nurses was 31.80 ± 7.69. Self-efficacy was positively correlated with palliative care knowledge (10.22 ± 2.30; r = 0.320, P < 0.05) and with self-reported hospice care practice (66.78 ± 13.39; r = 0.424, P < 0.05). Multivariate linear regression analysis revealed that hospital type, years of nursing experience, experience caring for dying patients, prior hospice care training, level of palliative care knowledge, and self-reported practice scores (P < 0.05) were significant predictors of palliative care self-efficacy. Conclusion Targeted interventions addressing these identified factors are recommended to enhance oncology nurses’ palliative care self-efficacy, thereby improving the quality of hospice care delivered in oncology settings. Oncology Nurses Palliative Care Knowledge Palliative Care Self-Efficacy Questionnaire Survey Background Palliative care is a patient- and family-centered approach that aims to improve the quality of life of patients with life-threatening or life-limiting illnesses and their families. With the rapid growth in the burden of chronic diseases and the accelerated aging of the global population, the demand for palliative care services has increased substantially and is expected to continue rising in the coming decades [ 1 ] . In China, the challenges posed by a rapidly aging society and the persistently high incidence of cancer have further highlighted the urgent need for effective and high-quality palliative care services. Within this context, oncology nurses play a pivotal role in the delivery of palliative care, as they are closely involved in symptom management, psychosocial support, and end-of-life decision-making [ 2 ] . Previous studies have demonstrated that nurses’ knowledge of palliative care and their level of self-efficacy are critical determinants of the quality of end-of-life care [ 3 – 6 ] . Self-efficacy refers to an individual’s belief in their ability to successfully perform specific tasks or behaviors in a given context [ 7 ] . It has been widely recognized as a key predictor of clinical performance and care quality in palliative care settings [ 8 , 9 ] .Therefore, identifying and examining the factors influencing oncology nurses’ self-efficacy in palliative care is essential for improving the quality of end-of-life care and optimizing palliative care outcomes. In recent years, international research on nurses’ self-efficacy in palliative care has gradually increased. A growing body of studieshas focused on strategies to enhance nurses’ self-efficacy, particularly through education and training interventions [ 10 , 11 ] . Evidence consistently suggests that systematic palliative care training programs can significantly improve nurses’ self-efficacy and their perceived competence in providing end-of-life care [ 12 , 13 ] .However, compared with international research, empirical studies examining the self-efficacy of oncology nurses in palliative care within the Chinese context remain relatively limited. Given the essential role of palliative care in oncology nursing practice and the current insufficiency of related evidence in China, there is a clear need for further investigation in this area. Therefore, the present study aims to assess the current level of palliative care self-efficacy among oncology nurses and to conduct an in-depth analysis of the factors influencing self-efficacy. The findings are expected to provide an empirical basis for the development of targeted education, training, and intervention strategies, thereby enhancing nurses’ self-efficacy and ultimately improving the quality of palliative care delivered to patients and their families. Subjects and Methods Study Subjects This study employed a convenience sampling method to recruit oncology nurses from 22 secondary- and tertiary-level hospitals in Tianjin between February and April 2025.The inclusion criteria were as follows: (1) holding a valid nursing qualification certificate; (2) having worked in an oncology department for at least one year; and (3) voluntary participation in the study. The exclusion criteria included: (1) nurses from other institutions who were temporarily undertaking further training at the study hospitals; and (2) nurses currently undergoing internship or practical training. All participants were fully informed about the study and participated voluntarily. The sample size was estimated based on the principle of 5–10 participants per variable, with an additional allowance for potential sample loss and invalid responses. A dropout rate of 10% was therefore added. Given that 50 variables were included in this study, the calculated sample size ranged from 275 to 550 participants. Accordingly, a target sample size of 400 nurses was planned. Ultimately, 381 nurses completed the survey and were included in the final analysis. Ethical considerations This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval for this research was obtained from the Medical Ethics Committee of Tianjin Medical University Cancer Institute (Approval No. bc20240051). Participation in this study was entirely voluntary, and they were provided with a detailed information sheet that explained the purpose, procedures, potential risks, and benefits of the study. Written informed consent was obtained from each participant before they proceeded to the questionnaire. To encourage candid responses, respondent anonymity was strictly guaranteed throughout the survey process. Survey Instruments General Information Questionnaire The General Information Questionnaire was designed by the research team to collect demographic and professional characteristics of oncology nurses, as well as their experiences and training related to palliative care. The questionnaire comprised 13 items and covered the following domains: Hospital information: hospital level (secondary or tertiary hospital) and hospital type (oncology specialty hospital or general hospital); Nurse demographic characteristics: gender, age, marital status, religious belief, and educational level; Professional background: years of work experience, professional title, and position; Palliative care–related experience: experience in caring for dying patients, status as a specialized palliative care nurse, and receipt of formal palliative care training. Chinese Version of Palliative Care Self-Efficacy Scale(C-PCSS) The Chinese Version of the Palliative Care Self-Efficacy Scale (C-PCSS) was adapted from the original English Palliative Care Self-Efficacy Scale (PCSS), which was developed in 2003 to assess self-efficacy among palliative care professionals [ 14 ] . In 2024, Guo et al. translated and cross-culturally adapted the PCSS to ensure cultural relevance and applicability within the Chinese context [ 15 ] . The C-PCSS consists of 12 items across two dimensions: (1) perceived ability to deal with end-of-life care issues (six items, Items 1–6), including responding to patients’ questions about the dying process and providing emotional support to family members; and (2) perceived ability to manage end-of-life symptoms (six items, Items 7–12), such as pain management and relief of dyspnea. Items are rated on a 4-point Likert scale ranging from 1 (“need further instruction”) to 4 (“able to complete independently”). Total scores range from 12 to 48, with higher scores indicating greater self-efficacy in palliative care.The C-PCSS has demonstrated excellent psychometric properties. The Cronbach’s α coefficient for the total scale was 0.943, and the split-half reliability coefficient was 0.844, indicating high internal consistency. Content validity was satisfactory, with item-level content validity indices (I-CVI) ranging from 0.857 to 1.000 and a scale-level average content validity index (S-CVI/Ave) of 0.956. The Palliative care quiz for nursing(PCQN) The Palliative Care Quiz for Nursing (PCQN) is a standardized instrument developed by Ross et al. at the University of Ottawa, Canada, to assess nurses’ knowledge of palliative care. The questionnaire was translated and culturally adapted for use in China by Chinese scholars, including Zou Min [ 16 ] , and has been widely applied in domestic nursing research.The PCQN comprises 20 items across three domains: philosophy and principles of palliative care (four items), pain and symptom management (13 items), and psychosocial support (three items). Each item provides three response options: “true,” “false,” and “don’t know.” Correct answers are scored as 1 point, while incorrect or “don’t know” responses are scored as 0 points. Higher total scores indicate a higher level of palliative care knowledge.The PCQN has shown acceptable reliability and validity. Test–retest reliability coefficients range from 0.714 to 0.758, and the Cronbach’s α coefficient for the total scale is 0.758. Correlation coefficients between the three subscales and the total score range from 0.541 to 0.835. Palliative Care Self Reported Practices Scale ( PCPS) The Palliative Care Self-Reported Practices Scale (PCPS) was developed by Nakazawa et al [ 17 ] . to assess nurses’ self-reported performance in palliative care practice. The scale was translated and revised for use in the Chinese context by Zhao Xiaoyan and colleagues [ 18 ] .The PCPS consists of 18 items across six dimensions, with three items per dimension: end-of-life care, patient- and family-centered care, pain management, delirium management, dyspnea management, and communication. Items are rated on a 5-point Likert scale ranging from 1 (“never”) to 5 (“always”), with higher scores indicating better self-reported palliative care practice performance. The scale has demonstrated good internal consistency, with a Cronbach’s α coefficient of 0.948. Method of data collection Data collection was conducted with the assistance of the Palliative Care Committee of the Tianjin Nursing Society. Initially, the committee contacted the nursing departments of 22 secondary and tertiary hospitals in Tianjin to obtain institutional support and informed consent. During this process, detailed information was provided regarding the study objectives, eligibility criteria, questionnaire administration procedures, and key considerations for survey completion, ensuring that nursing administrators clearly understood the study protocol. The nursing departments of participating hospitals distributed a QR code linking to the electronic questionnaire via the WeChat platform. Oncology nurses completed the questionnaire anonymously and voluntarily. To enhance data quality and ensure independent responses, each questionnaire was restricted to a single submission per IP address. In addition, all questionnaire items were set as mandatory to prevent missing data. During the data collection phase, the research team systematically reviewed the exported Excel data. Questionnaires were considered invalid and excluded from the analysis if they met either of the following criteria: (1) all items were answered using the same response option, suggesting a lack of response variability; or (2) logical inconsistencies were identified, such as contradictory or mutually exclusive responses. These quality control procedures were implemented to ensure the reliability and validity of the final dataset. Statistical Analysis After data collection, the raw data were reviewed and cleaned in Excel to ensure accuracy and completeness. The cleaned dataset was then imported into SPSS version 26.0 for statistical analysis. Descriptive statistics were used to summarize the data. Categorical variables were presented as frequencies and percentages, while continuous variables were expressed as means ± standard deviations. Group comparisons were conducted using independent-samples t tests or one-way analysis of variance (ANOVA), as appropriate. Pearson’s correlation analysis was performed to examine the relationships between continuous variables. Multiple linear regression analysis was used to identify factors associated with palliative care self-efficacy among oncology nurses. All statistical tests were two-tailed, and a p value of < 0.05 was considered statistically significant. Results General Information of Oncology Nurses Significant differences in palliative care self-efficacy scores were observed across several demographic and professional characteristics of oncology nurses. Specifically, self-efficacy scores differed significantly by hospital type, age, marital status, years of work experience, level of perceived support, position, experience in caring for dying patients, specialization in palliative care nursing, and receipt of palliative care training (p < 0.05) (Table 1 ). Table 1 General Information of Oncology Nurses and Univariate Analysis of Self-Efficacy Scores (n = 381) Characteristic Number (%) Score ± SD F/t P Hospital Type General Hospital 123(32.28) 33.89 ± 7.88 t ≡ 3.716 < 0.001 Specialized Hospital 258(67.72) 30.81 ± 7.41 Male Male 13(3.41) 30.92 ± 6.86 t =-0.418 0.676 Female 368(96.59) 31.83 ± 7.73 Age ≤ 25 years 45(11.81) 28.71 ± 7.55 F ≡ 9.536 < 0.001 26–35 years 157(41.21) 30.80 ± 7.13a ≥ 36 years 179(46.98) 33.46 ± 7.85a Marital Status Married 112(29.40) 29.45 ± 7.20 t =-3.927 0.001 Unmarried 269(70.60) 32.78 ± 7.69 Religious Belief Yes 10(2.62) 29.20 ± 5.61 t =-1.084 0.279 No 371(97.38) 31.87 ± 7.73 Educational Level Associate Degree 19(4.99) 30.79 ± 8.89 F = 0.278 0.758 Bachelor's Degree 344(90.29) 31.81 ± 7.57 Graduate Degree or above 18(4.72) 32.67 ± 8.90 Working Years ≤ 5years 91(23.88) 28.46 ± 7.27 F = 12.857 10years 214(56.17) 33.20 ± 7.74a Professional Title Junior 201(52.75) 30.23 ± 7.37 F = 9.977 < 0.001 Intermediate 165(43.31) 33.35 ± 7.55a Senior 15(3.94) 35.80 ± 8.96a Position Nurse 360(94.49) 31.44 ± 7.57 t =-3.838 < 0.001 Head Nurse 21(5.51) 37.95 ± 7.31 Experience in Caring for Dying Patients Yes 314(82.41) 32.73 ± 7.54 t = 5.261 < 0.001 No 67(17.59) 27.46 ± 6.93 Are you a palliative care nurse specialist Yes 33(8.66) 40.88 ± 6.05 t = 7.607 < 0.001 No 348(91.34) 30.94 ± 7.27 Have you received formal hospice and palliative care training Yes 54(14.17) 40.07 ± 7.50 t = 9.478 < 0.001 No 327(85.83) 30.43 ± 6.83 Note t: two–sample independent t-test,F: one-way ANOVA;Years of work experience are reported as whole numbers Palliative Care Self-Efficacy, Knowledge, and Self-Reported Practice among Oncology Nurses The mean total palliative care self-efficacy score among oncology nurses was 31.80 ± 7.69, with an average item score of 2.65 ± 0.90. Within the dimension of perceived ability to address end-of-life concerns, the highest-scoring items were Item 6, Item 3, and Item 2. For the dimension of perceived ability to manage end-of-life symptoms, the highest-scoring items were Item 11, Item 7, and Item 10. Detailed item-level results are presented in Table 2 . Table 2 Top-Ranked Items on End-of-Life Care Self-Efficacy Among Nurses in a Specialized Cancer Hospital (n = 381) Items Related to End-of-Life Care Self-Efficacy Rank Score Total 2.65 ± 0.90 Perceived capability to answer end-of-life care concerns 6. Answering queries about the effects of certain medications 1 2.74 ± 0.91 3. Informing people of the support services available 2 2.70 ± 0.93 2. Supporting the patient or family member when they become upset 3 2.60 ± 0.90 4. Discussing different environmental options (e.g. hospital, home, accompaniment of family members) 4 2.34 ± 0.94 1.Answering patients questions about the dying process 5 2.28 ± 0.94 5. Discussing patient’s wishes for after their death 6 2.20 ± 0.90 Perceived capability to respond to patient’s end-of-life symptoms 11. Assessing and managing of constipation 1 3.05 ± 0.85 7. Assessing and managing of pain from the patient 2 3.03 ± 0.93 10. Assessing and managing of nausea/vomiting 3 3.01 ± 0.86 8. Assessing and managing of terminal delirium 4 2.66 ± 0.91 9. Assessing and managing of terminal dyspnea 5 2.60 ± 0.89 12. Helping and supporting for patients with limited decision-making capacity 6 2.59 ± 0.87 The mean palliative care knowledge score was 10.22 ± 2.30 (out of a possible 20 points), corresponding to an overall accuracy rate of 51.12%. Only Items 4, 8, and 18, which relate to delirium-related knowledge, were answered correctly by more than 80% of participants. In contrast, Items 13 and 5 demonstrated the lowest accuracy rates, at 4.99% and 4.46%, respectively (Table 3 ). Table 3 Accuracy-Based Ranking of End-of-Life Care Knowledge Among Oncology Nurses (n = 381) End-of-Life Care Knowledge Item Rank Correct Responses Correct Rate (%) 4.Adjuvant therapies are important in managing pain(T) 1 352 92.39 8.Individuals who are taking opioids should also follow a bowel regime(T) 2 341 89.50 18.Manifestations of chronic pain are different from those of acute pain(T) 3 328 86.09 15.Suffering and physical pain are synonymous(F) 4 275 72.18 14.In high doses, codeine causes more nausea and vomiting than morphine(T) 5 244 64.04 1.Palliative care is appropriate only in situations where there is evidence of a downhill trajectory or deterioration(F) 6 241 63.25 20.The pain threshold is lowered by anxiety or fatigue(T) 7 230 60.37 6.During the last days of life, the drowsiness associated with electrolyte imbalance may decrease the need for sedation(T) 8 222 58.27 16.Demerol is not an effective analgesic in the control of chronic pain(T) 8 222 58.27 12.The philosophy of palliative care is compatible with that of aggressive treatment(T) 10 207 54.33 10.During the terminal stages of an illness, drugs that can cause respiratory depression are appropriate for the treatment of severe dyspnoea(T) 11 206 54.07 7.Drug addiction is a major problem when morphine is used on a long-term basis for the management of pain(F) 12 186 48.82 11.Men generally reconcile their gnef more quickly than women(F) 13 182 47.77 3.The extent of the disease determines the method of pain treatment(F) 14 173 45.41 2.Morphine is the standard used to compare the analgesic effect of other opioids(T) 15 165 43.31 9.The provision of palliative care requires emotional detachment(F) 16 164 43.04 19.The loss of a distant or contentious relabonsbip is easier to resolve than tbe loss of one that is close or intimate(F) 17 70 18.37 17.The accumulation of losses renders burnout inevitable for those who seek work in palliative care(F) 18 51 13.39 13.The use of placebos is appropriate in the treatment of some types of pain(F) 19 19 4.99 5.It is crucial for family members to remain at the bedside until death occurs(F) 20 17 4.46 The overall mean score for self-reported palliative care practice was 66.78 ± 13.39, with an average item score of 3.71 ± 0.95. Among the practice dimensions, pain-related care received the highest scores, whereas delirium-related care received the lowest scores (Table 4 ). Table 4 Self-Reported End-of-Life Care Practice Levels Among Oncology Nurses (n = 381) Item Number of Items Total Score( \(\:\stackrel{-}{x}\) ±s) Mean Item Score ( \(\:\stackrel{-}{x}\) ±s) Total PCPS Score 18 66.78 ± 13.39 3.71 ± 0.95 Pain 3 11.91 ± 2.50 3.97 ± 0.90 Dying-phase care 3 11.25 ± 2.40 3.75 ± 0.90 Communication 3 11.27 ± 2.51 3.75 ± 0.96 Dyspnea 3 11.13 ± 2.55 3.71 ± 0.95 Patient- and family-centered care 3 11.05 ± 2.63 3.68 ± 0.93 Delirium 3 10.16 ± 2.77 3.39 ± 1.07 Correlations Among Palliative-Care Self-Efficacy, Knowledge, and Self-Reported End-of-Life Practice in Oncology Nurses Pearson correlation analysis demonstrated that palliative care self-efficacy was positively correlated with palliative care knowledge (r = 0.320, p < 0.05) and self-reported end-of-life practice (r = 0.424, p < 0.05). Detailed results are presented in Table 5 . Table 5 Pearson Correlation Analysis of Palliative Care Knowledge and Self-Reported End-of-Life Practice with Palliative Care Self-Efficacy 1.Perceived capability to answer end-of-life care concerns 1 2 3 4 5 1 2.Perceived capability to respond to patient’s end-of-life symptoms 0.618 ** 1 3.Total End-of-Life Care Self-Efficacy Score 0.893 ** 0.905 ** 1 4.End-of-Life Care Knowledge Level 0.261 ** 0.313 ** 0.320 ** 1 5.Total End-of-Life Care Self-Reported Practice Score 0.360 ** 0.401 ** 0.424 ** 0.175 ** 1 Multivariable Linear Regression of Palliative-Care Self-Efficacy in Oncology Nurses In the multivariable linear regression analysis, the total palliative care self-efficacy score of oncology nurses was used as the dependent variable. Independent variables entered into the model included factors that were statistically significant (p < 0.05) in the univariate analyses, as well as the total scores for palliative care knowledge and self-reported end-of-life practice. A stepwise regression approach was applied for variable selection, with entry and removal criteria set at p 0.05, respectively. Details of the variable selection process and model specifications are presented in Table 6 . The final regression model identified several factors that were independently and positively associated with palliative care self-efficacy, including employment in a specialized cancer hospital, having ≥ 6 years of clinical experience, previous experience in caring for dying patients, receipt of palliative care training, higher palliative care knowledge scores, and higher total self-reported end-of-life practice scores. Among these variables, the total self-reported end-of-life practice score demonstrated the strongest association with palliative care self-efficacy (Table 7 ). Table 6 Coding Scheme for Independent Variables Item Coding Method Hospital type General hospital = 0; Specialized cancer hospital = 1 Age group (years) Reference: ≤ 25. Dummy variables: 26–35 = (Z₁ = 1, Z₂ = 0); ≥ 36 = (Z₁ = 0, Z₂ = 1) Marital status Unmarried = 0; Married = 1 Years of experience (years) Reference: ≤ 5. Dummy variables: 6–10 = (Z₁ = 1, Z₂ = 0); ≥ 10 = (Z₁ = 0, Z₂ = 1) Professional title Reference: Junior. Dummy variables: Intermediate = (Z₁ = 1, Z₂ = 0); Senior = (Z₁ = 0, Z₂ = 1) Position Staff nurse = 0; Head nurse = 1 Ever cared for a dying patient No = 0; Yes = 1 Certified hospice specialist nurse No = 0; Yes = 1 Received formal hospice training No = 0; Yes = 1 Hospice knowledge level Entered as raw score Total self-reported hospice practice score Entered as raw score Table 7 Multivariable Linear Regression Analysis of Factors Influencing Nurses’ End-of-Life Care Self-Efficacy Predictor B SE β t P VIF (Constant) — 2.074 4.63 < 0.001 Hospital type (ref. General) 1.420 0.683 0.086 2.079 0.038 1.053 Experience 6–10 year (ref. ≤ 5 year) 1.926 0.954 0.100 2.018 0.044 1.502 Experience ≥ 10 year (ref. ≤ 5 year) 2.662 0.787 0.172 3.384 0.001 1.574 Cared for dying patient (ref. No) 2.424 0.873 0.120 2.777 0.006 1.141 Received formal hospice training (ref. No) 6.287 0.952 0.285 6.603 < 0.001 1.139 Hospice knowledge level 0.446 0.145 0.133 3.071 0.002 1.144 Hospice self-reported practice score 0.186 0.024 0.324 7.746 < 0.001 1.064 Note F = 33.784,P<0.001,R 2 = 0.388,AdjustedR 2 =0.377 Discussion Overall Palliative-Care Self-Efficacy of Oncology Nurses Is Above the Midpoint In the present study, oncology nurses achieved a mean palliative care self-efficacy score of 31.80 ± 7.69, which was higher than the theoretical midpoint of the scale (24), indicating that overall self-efficacy was above a moderate level. Compared with previous studies, this score exceeded those reported by Awad et al. among intensive care unit (ICU) nurses [ 19 ] and by Lin et al. among nurses working in ICU and general wards [ 20 ] , but was lower than the levels observed by Kim et al. in a comprehensive cancer center [ 11 ] and by Barnett et al. among hospice nurses [ 21 ] . These variations may reflect differences in clinical context and professional exposure. Oncology nurses routinely care for patients with progressive, life-limiting illnesses and therefore accumulate extensive experience in symptom management, psychosocial support, and end-of-life decision-making. Given the complexity and high emotional burden associated with malignant disease, self-efficacy is particularly critical in oncology settings, as it directly influences nurses’ ability to deliver individualized and high-quality palliative care. Accordingly, the present study focused specifically on oncology nurses to enhance the contextual relevance and practical applicability of the findings. Regarding subscale performance, perceived ability to manage terminal symptoms scored higher than perceived ability to address end-of-life care issues. Notably, several items demonstrated comparatively low scores, including discussing post-mortem arrangements, responding to patients’ questions about the dying process, and discussing preferred place of death. These findings indicate persistent challenges in nurses’ confidence when engaging in sensitive end-of-life conversations.Within the Chinese cultural context, death is often considered a taboo subject, and explicit discussions about dying or post-mortem arrangements may be perceived as distressing or inauspicious. As a result, nurses may hesitate to initiate such conversations or may lack confidence in managing patients’ emotional responses. Moreover, these interactions require advanced communication skills and psychological resilience, which may not be adequately addressed in routine clinical training. These cultural and professional barriers likely contribute to the lower self-efficacy observed in these domains. To address these gaps, nursing managers should adopt multifaceted strategies, including culturally sensitive education to normalize end-of-life discussions, structured training in advanced communication skills, targeted psychological support to alleviate death-related anxiety, and organizational support that facilitates open and compassionate dialogue. Such integrated interventions are essential for strengthening nurses’ self-efficacy in end-of-life care and improving the overall quality of palliative services. Palliative Care Knowledge Is Moderately and Positively Associated with Self-Efficacy The oncology nurses in this study demonstrated a moderate level of palliative care knowledge, with a mean PCQN score of 10.22 ± 2.30, corresponding to an accuracy rate of 51.12%. This level was higher than that reported in our previous large-scale survey conducted in Tianjin in 2022 [ 22 ] and exceeded the pooled mean reported in Ling Li’s systematic review [ 23 ] , but remained lower than findings reported among nurses and clinicians in Beijing, Shanghai, and European settings [ 24 – 26 ] .A notable finding was the high proportion of nurses endorsing the statement that family members should remain at the bedside until death occurs, contrary to the original PCQN scoring key. Similar patterns have been reported in other Asian studies [ 11 ] , underscoring the importance of cultural context in interpreting PCQN responses. In Chinese and broader East Asian cultures, family presence at the end of life is widely regarded as integral to a “good death,” [ 27 ] and this cultural value appears to shape nurses’ knowledge appraisal and response patterns.Importantly, palliative care knowledge was significantly and positively correlated with self-efficacy. Nurses with higher knowledge levels tended to report greater confidence in delivering palliative care, consistent with prior studies [ 11 , 20 ] . Knowledge equips nurses with a clearer understanding of clinical principles and interventions, thereby reducing uncertainty and enhancing confidence in clinical decision-making. These findings highlight palliative care knowledge as a critical foundation for self-efficacy. Nursing administrators should therefore prioritize continuous, evidence-based education that integrates updated guidelines, expert consensus, and real-world clinical scenarios. Educational strategies such as simulation training, case-based learning, and reflective supervision may further facilitate the translation of knowledge into confident practice. Self-Reported End-of-Life Care Practice Is Positively Associated with Self-Efficacy The mean total score for self-reported palliative care practice indicated that oncology nurses perceived themselves as relatively competent in end-of-life care. This finding is consistent with previous reports from Japan and China [ 28 , 29 ] . Among practice domains, pain management received the highest ratings, whereas delirium management scored lowest. Delirium is a common and distressing complication in palliative care settings, yet nurses often report limited confidence in its assessment and management. The present findings align with prior studies identifying delirium care as a key challenge for nurses [ 30 ] . Given that delirium management requires rapid assessment, interdisciplinary collaboration, and nuanced clinical judgment, insufficient training and limited clinical exposure may contribute to lower self-efficacy in this domain. A moderate positive correlation was observed between self-reported end-of-life care practice and self-efficacy, suggesting that hands-on experience plays a crucial role in reinforcing nurses’ confidence. Practice opportunities enable nurses to apply knowledge, refine skills, and experience positive patient outcomes, all of which strengthen professional self-efficacy. Providing practical support tools and fostering multidisciplinary teamwork may further facilitate this process. Analysis of factors influencing the Palliative Care Self-Efficacy among Oncology Nurses Multivariable regression analysis identified several factors independently associated with higher self-efficacy, including employment in specialized cancer hospitals, longer oncology experience, prior care of dying patients, receipt of palliative care training, higher knowledge levels, and stronger self-reported practice performance. Nurses working in specialized cancer hospitals reported higher self-efficacy than those in general hospitals, likely reflecting greater access to specialized training, academic resources, and complex clinical cases. To reduce this disparity, oncology nursing leaders in general hospitals should expand access to structured education, academic exchange, and clinical mentorship opportunities. Participation in palliative care training emerged as a particularly strong predictor of self-efficacy. Nurses who had received formal training reported substantially higher confidence than those who had not, underscoring the value of systematic education. Given the limited integration of palliative care into undergraduate nursing curricula in China, introducing standardized palliative care courses may be an effective long-term strategy for strengthening foundational competence. In addition, years of oncology experience and prior care of dying patients were associated with higher self-efficacy. Repeated exposure to end-of-life care allows nurses to develop clinical judgment, emotional resilience, and a sense of professional accomplishment, all of which contribute to sustained confidence in palliative care delivery. Limitations Several limitations should be acknowledged. First, the sample was drawn primarily from tertiary hospitals, which may limit the generalizability of the findings to nurses working in secondary or primary care settings. Second, the study was conducted in a single metropolitan area, potentially introducing regional bias. Future multicenter studies involving diverse geographic regions and healthcare levels are warranted to validate and extend these findings. Conclusions This study provides a comprehensive examination of oncology nurses’ palliative care self-efficacy and its associated factors. Although challenges remain in sensitive areas such as discussing death, overall self-efficacy was above the scale midpoint, and knowledge and practice levels were moderate. Self-efficacy was positively associated with palliative care knowledge and self-reported practice, as well as institutional and experiential factors.Enhancing oncology nurses’ self-efficacy requires sustained investment in education, clinical exposure, and organizational support. By strengthening training programs, expanding practice opportunities, and fostering multidisciplinary collaboration, healthcare institutions can improve nurses’ confidence and ultimately deliver higher-quality, patient- and family-centered palliative care. Declarations Ethics approval and consent to participate The ethical review was conducted by the Medical Ethics Committee of Tianjin Medical University Cancer Institute (Approval No. bc20240051). It was performed in accordance with the guidelines of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their involvement in the study. Clinical trial number Not applicable Consent for publication Not applicable Competing interests The authors declare no competing interests. Funding: This work was supported by Tianjin Key Medical Discipline Construction Project (Grant No. TJYXZDXK-3-003A). The funder had no role in the study design, data collection, analysis, or interpretation, nor in the writing of the manuscript or the decision to submit it for publication. Author Contribution Meiling Lu made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data, and manuscript review and editing. Shuang Yang contributed to data curation, analysis, interpretation, and manuscript review and editing. Shuang Yang, and Zhang Zhang participated in data collection and organization. Zhang Zhang oversaw the study design, data interpretation, and manuscript revision. All authors have read and approved the final version of the manuscript. Acknowledgements The authors acknowledge the participants for their acceptance to participate in the study. Data Availability The raw data supporting the conclusions of this article will be made available by asking the corresponding author. References SLEEMAN K E, DE BRITO M ETKINDS, et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions [J]. Lancet Global health. 2019;7(7):e883–92. CHALLINOR JM, GALASSI A L, AL-RUZZIEH M, A, et al. Nursing's Potential to Address the Growing Cancer Burden in Low- and Middle-Income Countries [J]. J Glob Oncol. 2016;2(3):154–63. HARDEN K, PRICE D. Palliative Care: Improving Nursing Knowledge, Attitudes, and Behaviors [J]. Clin J Oncol Nurs. 2017;21(5):E232–8. BANDURA A. Self-efficacy: toward a unifying theory of behavioral change [J]. Psychol Rev, 1977, 84(2): 191–215. HSU H Y, CHEN YM. [The Correlates of Nurses' Self-Efficacy for End-of-Life Care] [J]. Hu li za zhi. J Nurs. 2019;66(5):32–43. BROGLIO K, BOOKBINDER M. Pilot of an online introduction to palliative care for nurses [J]. J Hospice Palliat Nurs. 2014;16(7):420–9. BRAUN M. Associations between oncology nurses' attitudes toward death and caring for dying patients [J]. Oncol Nurs Forum. 2010;37(1):E43–9. HENOCH I, DANIELSON E. Training intervention for health care staff in the provision of existential support to patients with cancer: a randomized, controlled study [J]. J Pain Symptom Manage. 2013;46(6):785–94. PHILLIPS J, SALAMONSON Y, DAVIDSON PM. An instrument to assess nurses' and care assistants' self-efficacy to provide a palliative approach to older people in residential aged care: a validation study [J]. Int J Nurs Stud. 2011;48(9):1096–100. CHA E, LEE S, LEE J, et al. Health Personnel's Knowledge, Attitudes, and Self-Efficacy Related to Providing Palliative Care in Persons with Chronic Diseases [J]. Han'guk Hosup'isu Wanhwa Uiryo Hakhoe chi = The. Korean J hospice Palliat care. 2020;23(4):198–211. KIM JS, KIM J. Knowledge, attitude and self-efficacy towards palliative care among nurses in Mongolia: A cross-sectional descriptive study [J]. PLoS ONE. 2020;15(7):e0236390. DEFUSCO C, LEWIS A. Improving Critical Care Nurses Perceived Self-Efficacy in Providing Palliative Care: A Quasi-Experimental Study [J]. Am J Hosp Palliat Care. 2023;40(2):117–21. SALMANI N, KESHMIRI F, BAGHERI I. The effect of combined training (theoretical-practical) of palliative care on perceived self-efficacy of nursing students [J]. PLoS ONE. 2024;19(7):e0302938. EAGAR K, SENIOR K, FILDES D et al. The palliative care evaluation tool kit: a compendium of tools to aid in the evaluation of palliative care projects [J]. 2004. GUO J, CHEN Y, SHEN B, et al. Translation and validation of the Chinese version of Palliative Care Self-Efficacy Scale [J]. Palliative & supportive care; 2024. pp. 1–7. MIN Z. Study on status quo of nurses' knowledge andattitudes on palliative care in Shanghai. [D]; Naval Medical University; 2007. NAKAZAWA Y, MIYASHITA M, MORITA T, et al. The palliative care self-reported practices scale and the palliative care difficulties scale: reliability and validity of two scales evaluating self-reported practices and difficulties experienced in palliative care by health professionals [J]. J Palliat Med. 2010;13(4):427–37. XIAOYAN Z, XIUXIU H, QIAOQIN W, et al. Reliability and validity of the Chinese version of the Palliative Care Self-Reported Practices Scale [J]. Chin Nurs Manage. 2021;21(09):1309–13. AWAD B, BATRAN A, MALAK M Z, et al. Knowledge, attitudes, and self-efficacy regarding palliative care among Palestinian nurses in intensive care units [J]. BMC Nurs. 2025;24(1):435. FADAEI S, AZIZZADEH FOROUZI M, MIYASHITA M, et al. Palliative care knowledge and self-efficacy: a comparative study between intensive care units and general units nurses [J]. BMC Palliat care. 2024;23(1):246. BARNETT M D, REED C M, ADAMS CM. Death Attitudes, Palliative Care Self-efficacy, and Attitudes Toward Care of the Dying Among Hospice Nurses [J]. J Clin Psychol Med Settings. 2021;28(2):295–300. MEILING L, ZHIQIN L, WANMIN Q. Current status and influencing factors of knowledge, attitude and practice of palliative care among nurses in Tianjin [J]. Tianjin J Nurs. 2023;31(06):631–6. LI L, WANG F, LIANG Q, et al. Nurses knowledge of palliative care: systematic review and meta-analysis [J]. BMJ Support Palliat Care; 2023. CHOVER-SIERRA E, MARTíNEZ-SABATER A, LAPEñA-MOñUX Y. Knowledge in palliative care of nursing professionals at a Spanish hospital [J]. Revista latino-americana de enfermagem; 2017. p. 25e2847. DI G, FAN D, XIAOYA Z, et al. Current status of knowledge, attitude and practice of palliative care among nurses in Beijing general hospitals and its influencing factors [J]. Chin J Mod Nurs. 2021;27(27):3680–6. XIAOHAN T, LIMEI J. Survey onattitudeandinfluencingfactors of hospicecareamonghealthprovidersinShanghai [J]. Chin J Gen Practitioners. 2021;20(5):556–61. YUJIE R, YUEFEN P, CHENGLIANG W, et al. Research progress of supportive needs of family caregivers of terminally ill patients [J]. Psychologies Magazine. 2025;20(05):237–40. SATO K, INOUE Y, UMEDA M, et al. A Japanese region-wide survey of the knowledge, difficulties and self-reported palliative care practices among nurses [J]. Jpn J Clin Oncol. 2014;44(8):718–28. KUDUBES A A, MURAT BEKTAS R, DIJLE AYAR R, et al. Palliative care difficulties and psychometric properties of the Turkish version of the self-esteem based palliative care practice scale [J]. Int J Caring Sci. 2019;12(1):162–75. GIBBS K D JR, MAHON M M, TRUSS M, et al. An Assessment of Hospital-Based Palliative Care in Maryland: Infrastructure, Barriers, and Opportunities [J]. J Pain Symptom Manage. 2015;49(6):1102–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 29 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers invited by journal 30 Mar, 2026 Editor invited by journal 27 Mar, 2026 Editor assigned by journal 25 Mar, 2026 Submission checks completed at journal 25 Mar, 2026 First submitted to journal 22 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-9194676","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":615249790,"identity":"c28c3425-4679-433e-96d1-e86c15b84b0c","order_by":0,"name":"Meiling Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYBACfvb2ww8+VPyXk2dvIFKLZM+ZNMMZZ5iNDXsOEKnF4EaCgTRvG3Niw40EYrWcOZBgwHOGzZhx5uONNxhqbKIJO+x444EHEhU8cuzSacUWDMfSchsIaeED2WJwRsKYcXaOmQRjw2HCWhiAfpFIbDNIbLh5hkgtAiAtB9sSgN7nIVILOJAbzhwABjLQLwnE+AUUlY//VBwARuXhjTc+1NgQ4RckYCCRQIpyiBZSdYyCUTAKRsHIAABgjkaT4kn0vwAAAABJRU5ErkJggg==","orcid":"","institution":"Tianjin Medical University Cancer Institute \u0026 Hospital, National Clinical Research Center for Cancer","correspondingAuthor":true,"prefix":"","firstName":"Meiling","middleName":"","lastName":"Lu","suffix":""},{"id":615249792,"identity":"e9b9ded5-dee9-47aa-8e6b-1391806d66ee","order_by":1,"name":"Shuang Yang","email":"","orcid":"","institution":"Tianjin Medical University Cancer Institute \u0026 Hospital, National Clinical Research Center for Cancer","correspondingAuthor":false,"prefix":"","firstName":"Shuang","middleName":"","lastName":"Yang","suffix":""},{"id":615249794,"identity":"db90587d-d239-4411-8d14-639afd486561","order_by":2,"name":"Simiao Yu","email":"","orcid":"","institution":"Tianjin Medical University Cancer Institute \u0026 Hospital, National Clinical Research Center for Cancer","correspondingAuthor":false,"prefix":"","firstName":"Simiao","middleName":"","lastName":"Yu","suffix":""},{"id":615249795,"identity":"96098532-8838-4afe-80a6-c74f4ac60b52","order_by":3,"name":"Zhang Zhang","email":"","orcid":"","institution":"Tianjin Medical University Cancer Institute \u0026 Hospital, National Clinical Research Center for Cancer","correspondingAuthor":false,"prefix":"","firstName":"Zhang","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-03-23 02:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9194676/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9194676/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105941478,"identity":"a208eb0d-f155-4e91-8fab-7e8975765e5b","added_by":"auto","created_at":"2026-04-01 15:56:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1420114,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9194676/v1/cd480084-f2d2-46e0-ac0c-2b1e27a3989d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Self-efficacy of oncology nurses in palliative-care: an Analysis of the current status and influencing factors","fulltext":[{"header":"Background","content":"\u003cp\u003ePalliative care is a patient- and family-centered approach that aims to improve the quality of life of patients with life-threatening or life-limiting illnesses and their families. With the rapid growth in the burden of chronic diseases and the accelerated aging of the global population, the demand for palliative care services has increased substantially and is expected to continue rising in the coming decades\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In China, the challenges posed by a rapidly aging society and the persistently high incidence of cancer have further highlighted the urgent need for effective and high-quality palliative care services. Within this context, oncology nurses play a pivotal role in the delivery of palliative care, as they are closely involved in symptom management, psychosocial support, and end-of-life decision-making\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Previous studies have demonstrated that nurses\u0026rsquo; knowledge of palliative care and their level of self-efficacy are critical determinants of the quality of end-of-life care\u003csup\u003e[\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Self-efficacy refers to an individual\u0026rsquo;s belief in their ability to successfully perform specific tasks or behaviors in a given context\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. It has been widely recognized as a key predictor of clinical performance and care quality in palliative care settings\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.Therefore, identifying and examining the factors influencing oncology nurses\u0026rsquo; self-efficacy in palliative care is essential for improving the quality of end-of-life care and optimizing palliative care outcomes.\u003c/p\u003e \u003cp\u003eIn recent years, international research on nurses\u0026rsquo; self-efficacy in palliative care has gradually increased. A growing body of studieshas focused on strategies to enhance nurses\u0026rsquo; self-efficacy, particularly through education and training interventions\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Evidence consistently suggests that systematic palliative care training programs can significantly improve nurses\u0026rsquo; self-efficacy and their perceived competence in providing end-of-life care\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.However, compared with international research, empirical studies examining the self-efficacy of oncology nurses in palliative care within the Chinese context remain relatively limited. Given the essential role of palliative care in oncology nursing practice and the current insufficiency of related evidence in China, there is a clear need for further investigation in this area. Therefore, the present study aims to assess the current level of palliative care self-efficacy among oncology nurses and to conduct an in-depth analysis of the factors influencing self-efficacy. The findings are expected to provide an empirical basis for the development of targeted education, training, and intervention strategies, thereby enhancing nurses\u0026rsquo; self-efficacy and ultimately improving the quality of palliative care delivered to patients and their families.\u003c/p\u003e"},{"header":"Subjects and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Subjects\u003c/h2\u003e \u003cp\u003eThis study employed a convenience sampling method to recruit oncology nurses from 22 secondary- and tertiary-level hospitals in Tianjin between February and April 2025.The inclusion criteria were as follows: (1) holding a valid nursing qualification certificate; (2) having worked in an oncology department for at least one year; and (3) voluntary participation in the study. The exclusion criteria included: (1) nurses from other institutions who were temporarily undertaking further training at the study hospitals; and (2) nurses currently undergoing internship or practical training.\u003c/p\u003e \u003cp\u003eAll participants were fully informed about the study and participated voluntarily. The sample size was estimated based on the principle of 5\u0026ndash;10 participants per variable, with an additional allowance for potential sample loss and invalid responses. A dropout rate of 10% was therefore added. Given that 50 variables were included in this study, the calculated sample size ranged from 275 to 550 participants. Accordingly, a target sample size of 400 nurses was planned. Ultimately, 381 nurses completed the survey and were included in the final analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval for this research was obtained from the Medical Ethics Committee of Tianjin Medical University Cancer Institute (Approval No. bc20240051). Participation in this study was entirely voluntary, and they were provided with a detailed information sheet that explained the purpose, procedures, potential risks, and benefits of the study. Written informed consent was obtained from each participant before they proceeded to the questionnaire. To encourage candid responses, respondent anonymity was strictly guaranteed throughout the survey process.\u003c/p\u003e\n\u003ch3\u003eSurvey Instruments\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information Questionnaire\u003c/h2\u003e \u003cp\u003eThe General Information Questionnaire was designed by the research team to collect demographic and professional characteristics of oncology nurses, as well as their experiences and training related to palliative care. The questionnaire comprised 13 items and covered the following domains:\u003c/p\u003e \u003cp\u003eHospital information: hospital level (secondary or tertiary hospital) and hospital type (oncology specialty hospital or general hospital);\u003c/p\u003e \u003cp\u003eNurse demographic characteristics: gender, age, marital status, religious belief, and educational level;\u003c/p\u003e \u003cp\u003eProfessional background: years of work experience, professional title, and position;\u003c/p\u003e \u003cp\u003ePalliative care\u0026ndash;related experience: experience in caring for dying patients, status as a specialized palliative care nurse, and receipt of formal palliative care training.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eChinese Version of Palliative Care Self-Efficacy Scale(C-PCSS)\u003c/h3\u003e\n\u003cp\u003eThe Chinese Version of the Palliative Care Self-Efficacy Scale (C-PCSS) was adapted from the original English Palliative Care Self-Efficacy Scale (PCSS), which was developed in 2003 to assess self-efficacy among palliative care professionals\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. In 2024, Guo et al. translated and cross-culturally adapted the PCSS to ensure cultural relevance and applicability within the Chinese context\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. The C-PCSS consists of 12 items across two dimensions: (1) perceived ability to deal with end-of-life care issues (six items, Items 1\u0026ndash;6), including responding to patients\u0026rsquo; questions about the dying process and providing emotional support to family members; and (2) perceived ability to manage end-of-life symptoms (six items, Items 7\u0026ndash;12), such as pain management and relief of dyspnea. Items are rated on a 4-point Likert scale ranging from 1 (\u0026ldquo;need further instruction\u0026rdquo;) to 4 (\u0026ldquo;able to complete independently\u0026rdquo;). Total scores range from 12 to 48, with higher scores indicating greater self-efficacy in palliative care.The C-PCSS has demonstrated excellent psychometric properties. The Cronbach\u0026rsquo;s α coefficient for the total scale was 0.943, and the split-half reliability coefficient was 0.844, indicating high internal consistency. Content validity was satisfactory, with item-level content validity indices (I-CVI) ranging from 0.857 to 1.000 and a scale-level average content validity index (S-CVI/Ave) of 0.956.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eThe Palliative care quiz for nursing(PCQN)\u003c/h2\u003e \u003cp\u003eThe Palliative Care Quiz for Nursing (PCQN) is a standardized instrument developed by Ross et al. at the University of Ottawa, Canada, to assess nurses\u0026rsquo; knowledge of palliative care. The questionnaire was translated and culturally adapted for use in China by Chinese scholars, including Zou Min\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, and has been widely applied in domestic nursing research.The PCQN comprises 20 items across three domains: philosophy and principles of palliative care (four items), pain and symptom management (13 items), and psychosocial support (three items). Each item provides three response options: \u0026ldquo;true,\u0026rdquo; \u0026ldquo;false,\u0026rdquo; and \u0026ldquo;don\u0026rsquo;t know.\u0026rdquo; Correct answers are scored as 1 point, while incorrect or \u0026ldquo;don\u0026rsquo;t know\u0026rdquo; responses are scored as 0 points. Higher total scores indicate a higher level of palliative care knowledge.The PCQN has shown acceptable reliability and validity. Test\u0026ndash;retest reliability coefficients range from 0.714 to 0.758, and the Cronbach\u0026rsquo;s α coefficient for the total scale is 0.758. Correlation coefficients between the three subscales and the total score range from 0.541 to 0.835.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePalliative Care Self Reported Practices Scale ( PCPS)\u003c/h3\u003e\n\u003cp\u003eThe Palliative Care Self-Reported Practices Scale (PCPS) was developed by Nakazawa et al\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. to assess nurses\u0026rsquo; self-reported performance in palliative care practice. The scale was translated and revised for use in the Chinese context by Zhao Xiaoyan and colleagues\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.The PCPS consists of 18 items across six dimensions, with three items per dimension: end-of-life care, patient- and family-centered care, pain management, delirium management, dyspnea management, and communication. Items are rated on a 5-point Likert scale ranging from 1 (\u0026ldquo;never\u0026rdquo;) to 5 (\u0026ldquo;always\u0026rdquo;), with higher scores indicating better self-reported palliative care practice performance. The scale has demonstrated good internal consistency, with a Cronbach\u0026rsquo;s α coefficient of 0.948.\u003c/p\u003e\n\u003ch3\u003eMethod of data collection\u003c/h3\u003e\n\u003cp\u003eData collection was conducted with the assistance of the Palliative Care Committee of the Tianjin Nursing Society. Initially, the committee contacted the nursing departments of 22 secondary and tertiary hospitals in Tianjin to obtain institutional support and informed consent. During this process, detailed information was provided regarding the study objectives, eligibility criteria, questionnaire administration procedures, and key considerations for survey completion, ensuring that nursing administrators clearly understood the study protocol.\u003c/p\u003e \u003cp\u003eThe nursing departments of participating hospitals distributed a QR code linking to the electronic questionnaire via the WeChat platform. Oncology nurses completed the questionnaire anonymously and voluntarily. To enhance data quality and ensure independent responses, each questionnaire was restricted to a single submission per IP address. In addition, all questionnaire items were set as mandatory to prevent missing data.\u003c/p\u003e \u003cp\u003eDuring the data collection phase, the research team systematically reviewed the exported Excel data. Questionnaires were considered invalid and excluded from the analysis if they met either of the following criteria: (1) all items were answered using the same response option, suggesting a lack of response variability; or (2) logical inconsistencies were identified, such as contradictory or mutually exclusive responses. These quality control procedures were implemented to ensure the reliability and validity of the final dataset.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAfter data collection, the raw data were reviewed and cleaned in Excel to ensure accuracy and completeness. The cleaned dataset was then imported into SPSS version 26.0 for statistical analysis.\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to summarize the data. Categorical variables were presented as frequencies and percentages, while continuous variables were expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations. Group comparisons were conducted using independent-samples t tests or one-way analysis of variance (ANOVA), as appropriate. Pearson\u0026rsquo;s correlation analysis was performed to examine the relationships between continuous variables. Multiple linear regression analysis was used to identify factors associated with palliative care self-efficacy among oncology nurses. All statistical tests were two-tailed, and a p value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eGeneral Information of Oncology Nurses\u003c/h2\u003e\n\u003cp\u003eSignificant differences in palliative care self-efficacy scores were observed across several demographic and professional characteristics of oncology nurses. Specifically, self-efficacy scores differed significantly by hospital type, age, marital status, years of work experience, level of perceived support, position, experience in caring for dying patients, specialization in palliative care nursing, and receipt of palliative care training (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eGeneral Information of Oncology Nurses and Univariate Analysis of Self-Efficacy Scores (n\u0026thinsp;=\u0026thinsp;381)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacteristic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eScore\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eF/t\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital Type\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGeneral Hospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e123(32.28)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.89\u0026thinsp;\u0026plusmn;\u0026thinsp;7.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;\u0026equiv;\u0026thinsp;3.716\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpecialized Hospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e258(67.72)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.81\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13(3.41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.92\u0026thinsp;\u0026plusmn;\u0026thinsp;6.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e=-0.418\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.676\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e368(96.59)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;\u0026thinsp;25 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45(11.81)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.71\u0026thinsp;\u0026plusmn;\u0026thinsp;7.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u0026thinsp;\u0026equiv;\u0026thinsp;9.536\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26\u0026ndash;35 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e157(41.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.80\u0026thinsp;\u0026plusmn;\u0026thinsp;7.13a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;36 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e179(46.98)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.46\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarital Status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e112(29.40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.45\u0026thinsp;\u0026plusmn;\u0026thinsp;7.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e=-3.927\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnmarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e269(70.60)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.78\u0026thinsp;\u0026plusmn;\u0026thinsp;7.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReligious Belief\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10(2.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e=-1.084\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.279\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e371(97.38)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEducational Level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAssociate Degree\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19(4.99)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.79\u0026thinsp;\u0026plusmn;\u0026thinsp;8.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.278\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.758\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBachelor's Degree\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e344(90.29)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.81\u0026thinsp;\u0026plusmn;\u0026thinsp;7.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGraduate Degree or above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18(4.72)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.67\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWorking Years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;\u0026thinsp;5years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e91(23.88)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.46\u0026thinsp;\u0026plusmn;\u0026thinsp;7.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12.857\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6-10years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e76(19.95)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.87\u0026thinsp;\u0026plusmn;\u0026thinsp;6.85a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;10years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e214(56.17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.20\u0026thinsp;\u0026plusmn;\u0026thinsp;7.74a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProfessional Title\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJunior\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e201(52.75)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.23\u0026thinsp;\u0026plusmn;\u0026thinsp;7.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9.977\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntermediate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e165(43.31)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.55a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSenior\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15(3.94)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35.80\u0026thinsp;\u0026plusmn;\u0026thinsp;8.96a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e360(94.49)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.44\u0026thinsp;\u0026plusmn;\u0026thinsp;7.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e=-3.838\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHead Nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21(5.51)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.95\u0026thinsp;\u0026plusmn;\u0026thinsp;7.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExperience in Caring for Dying Patients\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e314(82.41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.73\u0026thinsp;\u0026plusmn;\u0026thinsp;7.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.261\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e67(17.59)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.46\u0026thinsp;\u0026plusmn;\u0026thinsp;6.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAre you a palliative care nurse specialist\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33(8.66)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.88\u0026thinsp;\u0026plusmn;\u0026thinsp;6.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.607\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e348(91.34)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.94\u0026thinsp;\u0026plusmn;\u0026thinsp;7.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHave you received formal hospice and palliative care training\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54(14.17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.07\u0026thinsp;\u0026plusmn;\u0026thinsp;7.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9.478\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e327(85.83)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eNote t: two\u0026ndash;sample independent t-test,F: one-way ANOVA;Years of work experience are reported as whole numbers\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003ePalliative Care Self-Efficacy, Knowledge, and Self-Reported Practice among Oncology Nurses\u003c/h2\u003e\n\u003cp\u003eThe mean total palliative care self-efficacy score among oncology nurses was 31.80\u0026thinsp;\u0026plusmn;\u0026thinsp;7.69, with an average item score of 2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90. Within the dimension of perceived ability to address end-of-life concerns, the highest-scoring items were Item 6, Item 3, and Item 2. For the dimension of perceived ability to manage end-of-life symptoms, the highest-scoring items were Item 11, Item 7, and Item 10. Detailed item-level results are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eTop-Ranked Items on End-of-Life Care Self-Efficacy Among Nurses in a Specialized Cancer Hospital (n\u0026thinsp;=\u0026thinsp;381)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eItems Related to End-of-Life Care Self-Efficacy\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRank\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eScore\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived capability to answer end-of-life care concerns\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6. Answering queries about the effects of certain\u003c/p\u003e\n\u003cp\u003emedications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3. Informing people of the support services available\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2. Supporting the patient or family member when\u003c/p\u003e\n\u003cp\u003ethey become upset\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4. Discussing different environmental options\u003c/p\u003e\n\u003cp\u003e(e.g. hospital, home, accompaniment of family\u003c/p\u003e\n\u003cp\u003emembers)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.Answering patients questions about the dying\u003c/p\u003e\n\u003cp\u003eprocess\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5. Discussing patient\u0026rsquo;s wishes for after their death\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived capability to respond to patient\u0026rsquo;s end-of-life symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11. Assessing and managing of constipation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7. Assessing and managing of pain from the patient\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10. Assessing and managing of nausea/vomiting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8. Assessing and managing of terminal delirium\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9. Assessing and managing of terminal dyspnea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12. Helping and supporting for patients with limited\u003c/p\u003e\n\u003cp\u003edecision-making capacity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe mean palliative care knowledge score was 10.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30 (out of a possible 20 points), corresponding to an overall accuracy rate of 51.12%. Only Items 4, 8, and 18, which relate to delirium-related knowledge, were answered correctly by more than 80% of participants. In contrast, Items 13 and 5 demonstrated the lowest accuracy rates, at 4.99% and 4.46%, respectively (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAccuracy-Based Ranking of End-of-Life Care Knowledge Among Oncology Nurses (n\u0026thinsp;=\u0026thinsp;381)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEnd-of-Life Care Knowledge Item\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRank\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCorrect Responses\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCorrect Rate (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.Adjuvant therapies are important in managing pain(T)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e352\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e92.39\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.Individuals who are taking opioids should also follow a bowel regime(T)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e341\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e89.50\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.Manifestations of chronic pain are different from those of acute pain(T)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e328\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e86.09\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.Suffering and physical pain are synonymous(F)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e275\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.In high doses, codeine causes more nausea and vomiting than morphine(T)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e244\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.Palliative care is appropriate only in situations where there is evidence of a downhill trajectory or deterioration(F)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e241\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63.25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.The pain threshold is lowered by anxiety or fatigue(T)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e230\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60.37\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.During the last days of life, the drowsiness associated with electrolyte imbalance may decrease the need for sedation(T)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e222\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58.27\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.Demerol is not an effective analgesic in the control of chronic pain(T)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e222\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58.27\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.The philosophy of palliative care is compatible with that of aggressive treatment(T)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e207\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54.33\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.During the terminal stages of an illness, drugs that can cause respiratory depression are appropriate for the treatment of severe dyspnoea(T)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e206\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54.07\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.Drug addiction is a major problem when morphine is used on a long-term basis for the management of pain(F)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e186\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48.82\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.Men generally reconcile their gnef more quickly than women(F)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e182\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47.77\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.The extent of the disease determines the method of pain treatment(F)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e173\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45.41\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.Morphine is the standard used to compare the analgesic effect of other opioids(T)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e165\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43.31\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.The provision of palliative care requires emotional detachment(F)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e164\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.The loss of a distant or contentious relabonsbip is easier to resolve than tbe loss of one that is close or intimate(F)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18.37\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.The accumulation of losses renders burnout inevitable for those who seek work in palliative care(F)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13.39\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.The use of placebos is appropriate in the treatment of some types of pain(F)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.99\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.It is crucial for family members to remain at the bedside until death occurs(F)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.46\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe overall mean score for self-reported palliative care practice was 66.78\u0026thinsp;\u0026plusmn;\u0026thinsp;13.39, with an average item score of 3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95. Among the practice dimensions, pain-related care received the highest scores, whereas delirium-related care received the lowest scores (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSelf-Reported End-of-Life Care Practice Levels Among Oncology Nurses (n\u0026thinsp;=\u0026thinsp;381)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eItem\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber of Items\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal Score(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean Item Score (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn;s)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal PCPS Score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e66.78\u0026thinsp;\u0026plusmn;\u0026thinsp;13.39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.91\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDying-phase care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCommunication\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDyspnea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient- and family-centered care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDelirium\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e10.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eCorrelations Among Palliative-Care Self-Efficacy, Knowledge, and Self-Reported End-of-Life Practice in Oncology Nurses\u003c/h2\u003e\n\u003cp\u003ePearson correlation analysis demonstrated that palliative care self-efficacy was positively correlated with palliative care knowledge (r\u0026thinsp;=\u0026thinsp;0.320, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and self-reported end-of-life practice (r\u0026thinsp;=\u0026thinsp;0.424, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Detailed results are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePearson Correlation Analysis of Palliative Care Knowledge and Self-Reported End-of-Life Practice with Palliative Care Self-Efficacy\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1.Perceived capability to answer end-of-life care concerns\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.Perceived capability to respond to patient\u0026rsquo;s end-of-life symptoms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.618\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.Total End-of-Life Care Self-Efficacy Score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.893\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.905\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.End-of-Life Care Knowledge Level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.261\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.313\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.320\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.Total End-of-Life Care Self-Reported Practice Score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.360 \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.401\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.424\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.175\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eMultivariable Linear Regression of Palliative-Care Self-Efficacy in Oncology Nurses\u003c/h2\u003e\n\u003cp\u003eIn the multivariable linear regression analysis, the total palliative care self-efficacy score of oncology nurses was used as the dependent variable. Independent variables entered into the model included factors that were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the univariate analyses, as well as the total scores for palliative care knowledge and self-reported end-of-life practice. A stepwise regression approach was applied for variable selection, with entry and removal criteria set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, respectively. Details of the variable selection process and model specifications are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eThe final regression model identified several factors that were independently and positively associated with palliative care self-efficacy, including employment in a specialized cancer hospital, having\u0026thinsp;\u0026ge;\u0026thinsp;6 years of clinical experience, previous experience in caring for dying patients, receipt of palliative care training, higher palliative care knowledge scores, and higher total self-reported end-of-life practice scores. Among these variables, the total self-reported end-of-life practice score demonstrated the strongest association with palliative care self-efficacy (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCoding Scheme for Independent Variables\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;Item\u003c/div\u003e\n\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCoding Method\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital type\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGeneral hospital\u0026thinsp;=\u0026thinsp;0; Specialized cancer hospital\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge group (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference: \u0026le; 25. Dummy variables: 26\u0026ndash;35 = (Z₁ = 1, Z₂ = 0); \u0026ge; 36 = (Z₁ = 0, Z₂ = 1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnmarried\u0026thinsp;=\u0026thinsp;0; Married\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYears of experience (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference: \u0026le; 5. Dummy variables: 6\u0026ndash;10 = (Z₁ = 1, Z₂ = 0); \u0026ge; 10 = (Z₁ = 0, Z₂ = 1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProfessional title\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cp\u003eReference: Junior. Dummy variables: Intermediate = (Z₁ = 1, Z₂ = 0);\u003c/p\u003e\n\u003cp\u003eSenior = (Z₁ = 0, Z₂ = 1)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStaff nurse\u0026thinsp;=\u0026thinsp;0; Head nurse\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEver cared for a dying patient\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u0026thinsp;=\u0026thinsp;0; Yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCertified hospice specialist nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u0026thinsp;=\u0026thinsp;0; Yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReceived formal hospice training\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u0026thinsp;=\u0026thinsp;0; Yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospice knowledge level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEntered as raw score\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal self-reported hospice practice score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEntered as raw score\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab7\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultivariable Linear Regression Analysis of Factors Influencing Nurses\u0026rsquo; End-of-Life Care Self-Efficacy\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePredictor\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026beta;\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVIF\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(Constant)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.074\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital type (ref. General)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.420\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.683\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.086\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.079\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.038\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.053\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExperience 6\u0026ndash;10\u0026nbsp;year (ref. \u0026le; 5\u0026nbsp;year)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.926\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.954\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.044\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.502\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExperience\u0026thinsp;\u0026ge;\u0026thinsp;10\u0026nbsp;year (ref. \u0026le; 5\u0026nbsp;year)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.662\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.787\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.172\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.384\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.574\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCared for dying patient (ref. No)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.424\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.873\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.777\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.141\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\nReceived formal hospice training (ref. No)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.287\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.952\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.285\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.603\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.139\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospice knowledge level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.446\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.145\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.071\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.144\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospice self-reported practice score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.186\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.324\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.746\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.064\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003eNote F\u0026thinsp;=\u0026thinsp;33.784,P\u0026lt;0.001,R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.388,AdjustedR\u003csup\u003e2\u003c/sup\u003e=0.377\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eOverall Palliative-Care Self-Efficacy of Oncology Nurses Is Above the Midpoint\u003c/h2\u003e \u003cp\u003eIn the present study, oncology nurses achieved a mean palliative care self-efficacy score of 31.80\u0026thinsp;\u0026plusmn;\u0026thinsp;7.69, which was higher than the theoretical midpoint of the scale (24), indicating that overall self-efficacy was above a moderate level. Compared with previous studies, this score exceeded those reported by Awad et al. among intensive care unit (ICU) nurses\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e and by Lin et al. among nurses working in ICU and general wards\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, but was lower than the levels observed by Kim et al. in a comprehensive cancer center\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e and by Barnett et al. among hospice nurses\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThese variations may reflect differences in clinical context and professional exposure. Oncology nurses routinely care for patients with progressive, life-limiting illnesses and therefore accumulate extensive experience in symptom management, psychosocial support, and end-of-life decision-making. Given the complexity and high emotional burden associated with malignant disease, self-efficacy is particularly critical in oncology settings, as it directly influences nurses\u0026rsquo; ability to deliver individualized and high-quality palliative care. Accordingly, the present study focused specifically on oncology nurses to enhance the contextual relevance and practical applicability of the findings.\u003c/p\u003e \u003cp\u003eRegarding subscale performance, perceived ability to manage terminal symptoms scored higher than perceived ability to address end-of-life care issues. Notably, several items demonstrated comparatively low scores, including discussing post-mortem arrangements, responding to patients\u0026rsquo; questions about the dying process, and discussing preferred place of death. These findings indicate persistent challenges in nurses\u0026rsquo; confidence when engaging in sensitive end-of-life conversations.Within the Chinese cultural context, death is often considered a taboo subject, and explicit discussions about dying or post-mortem arrangements may be perceived as distressing or inauspicious. As a result, nurses may hesitate to initiate such conversations or may lack confidence in managing patients\u0026rsquo; emotional responses. Moreover, these interactions require advanced communication skills and psychological resilience, which may not be adequately addressed in routine clinical training. These cultural and professional barriers likely contribute to the lower self-efficacy observed in these domains.\u003c/p\u003e \u003cp\u003eTo address these gaps, nursing managers should adopt multifaceted strategies, including culturally sensitive education to normalize end-of-life discussions, structured training in advanced communication skills, targeted psychological support to alleviate death-related anxiety, and organizational support that facilitates open and compassionate dialogue. Such integrated interventions are essential for strengthening nurses\u0026rsquo; self-efficacy in end-of-life care and improving the overall quality of palliative services.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePalliative Care Knowledge Is Moderately and Positively Associated with Self-Efficacy\u003c/h2\u003e \u003cp\u003eThe oncology nurses in this study demonstrated a moderate level of palliative care knowledge, with a mean PCQN score of 10.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30, corresponding to an accuracy rate of 51.12%. This level was higher than that reported in our previous large-scale survey conducted in Tianjin in 2022\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e and exceeded the pooled mean reported in Ling Li\u0026rsquo;s systematic review\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, but remained lower than findings reported among nurses and clinicians in Beijing, Shanghai, and European settings\u003csup\u003e[\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.A notable finding was the high proportion of nurses endorsing the statement that family members should remain at the bedside until death occurs, contrary to the original PCQN scoring key. Similar patterns have been reported in other Asian studies\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, underscoring the importance of cultural context in interpreting PCQN responses. In Chinese and broader East Asian cultures, family presence at the end of life is widely regarded as integral to a \u0026ldquo;good death,\u0026rdquo;\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e and this cultural value appears to shape nurses\u0026rsquo; knowledge appraisal and response patterns.Importantly, palliative care knowledge was significantly and positively correlated with self-efficacy. Nurses with higher knowledge levels tended to report greater confidence in delivering palliative care, consistent with prior studies\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Knowledge equips nurses with a clearer understanding of clinical principles and interventions, thereby reducing uncertainty and enhancing confidence in clinical decision-making.\u003c/p\u003e \u003cp\u003eThese findings highlight palliative care knowledge as a critical foundation for self-efficacy. Nursing administrators should therefore prioritize continuous, evidence-based education that integrates updated guidelines, expert consensus, and real-world clinical scenarios. Educational strategies such as simulation training, case-based learning, and reflective supervision may further facilitate the translation of knowledge into confident practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSelf-Reported End-of-Life Care Practice Is Positively Associated with Self-Efficacy\u003c/h2\u003e \u003cp\u003eThe mean total score for self-reported palliative care practice indicated that oncology nurses perceived themselves as relatively competent in end-of-life care. This finding is consistent with previous reports from Japan and China\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Among practice domains, pain management received the highest ratings, whereas delirium management scored lowest.\u003c/p\u003e \u003cp\u003eDelirium is a common and distressing complication in palliative care settings, yet nurses often report limited confidence in its assessment and management. The present findings align with prior studies identifying delirium care as a key challenge for nurses\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Given that delirium management requires rapid assessment, interdisciplinary collaboration, and nuanced clinical judgment, insufficient training and limited clinical exposure may contribute to lower self-efficacy in this domain.\u003c/p\u003e \u003cp\u003eA moderate positive correlation was observed between self-reported end-of-life care practice and self-efficacy, suggesting that hands-on experience plays a crucial role in reinforcing nurses\u0026rsquo; confidence. Practice opportunities enable nurses to apply knowledge, refine skills, and experience positive patient outcomes, all of which strengthen professional self-efficacy. Providing practical support tools and fostering multidisciplinary teamwork may further facilitate this process.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis of factors influencing the Palliative Care Self-Efficacy among Oncology Nurses\u003c/h2\u003e \u003cp\u003eMultivariable regression analysis identified several factors independently associated with higher self-efficacy, including employment in specialized cancer hospitals, longer oncology experience, prior care of dying patients, receipt of palliative care training, higher knowledge levels, and stronger self-reported practice performance.\u003c/p\u003e \u003cp\u003eNurses working in specialized cancer hospitals reported higher self-efficacy than those in general hospitals, likely reflecting greater access to specialized training, academic resources, and complex clinical cases. To reduce this disparity, oncology nursing leaders in general hospitals should expand access to structured education, academic exchange, and clinical mentorship opportunities.\u003c/p\u003e \u003cp\u003eParticipation in palliative care training emerged as a particularly strong predictor of self-efficacy. Nurses who had received formal training reported substantially higher confidence than those who had not, underscoring the value of systematic education. Given the limited integration of palliative care into undergraduate nursing curricula in China, introducing standardized palliative care courses may be an effective long-term strategy for strengthening foundational competence.\u003c/p\u003e \u003cp\u003eIn addition, years of oncology experience and prior care of dying patients were associated with higher self-efficacy. Repeated exposure to end-of-life care allows nurses to develop clinical judgment, emotional resilience, and a sense of professional accomplishment, all of which contribute to sustained confidence in palliative care delivery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations should be acknowledged. First, the sample was drawn primarily from tertiary hospitals, which may limit the generalizability of the findings to nurses working in secondary or primary care settings. Second, the study was conducted in a single metropolitan area, potentially introducing regional bias. Future multicenter studies involving diverse geographic regions and healthcare levels are warranted to validate and extend these findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides a comprehensive examination of oncology nurses\u0026rsquo; palliative care self-efficacy and its associated factors. Although challenges remain in sensitive areas such as discussing death, overall self-efficacy was above the scale midpoint, and knowledge and practice levels were moderate. Self-efficacy was positively associated with palliative care knowledge and self-reported practice, as well as institutional and experiential factors.Enhancing oncology nurses\u0026rsquo; self-efficacy requires sustained investment in education, clinical exposure, and organizational support. By strengthening training programs, expanding practice opportunities, and fostering multidisciplinary collaboration, healthcare institutions can improve nurses\u0026rsquo; confidence and ultimately deliver higher-quality, patient- and family-centered palliative care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e The ethical review was conducted by the Medical Ethics Committee of Tianjin Medical University Cancer Institute (Approval No. bc20240051). It was performed in accordance with the guidelines of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their involvement in the study.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis work was supported by Tianjin Key Medical Discipline Construction Project (Grant No. TJYXZDXK-3-003A). The funder had no role in the study design, data collection, analysis, or interpretation, nor in the writing of the manuscript or the decision to submit it for publication.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMeiling Lu made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data, and manuscript review and editing. Shuang Yang contributed to data curation, analysis, interpretation, and manuscript review and editing. Shuang Yang, and Zhang Zhang participated in data collection and organization. Zhang Zhang oversaw the study design, data interpretation, and manuscript revision. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors acknowledge the participants for their acceptance to participate in the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe raw data supporting the conclusions of this article will be made available by asking the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSLEEMAN K E, DE BRITO M ETKINDS, et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions [J]. Lancet Global health. 2019;7(7):e883\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHALLINOR JM, GALASSI A L, AL-RUZZIEH M, A, et al. Nursing's Potential to Address the Growing Cancer Burden in Low- and Middle-Income Countries [J]. J Glob Oncol. 2016;2(3):154\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHARDEN K, PRICE D. Palliative Care: Improving Nursing Knowledge, Attitudes, and Behaviors [J]. Clin J Oncol Nurs. 2017;21(5):E232\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBANDURA A. Self-efficacy: toward a unifying theory of behavioral change [J]. Psychol Rev, 1977, 84(2): 191\u0026ndash;215.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHSU H Y, CHEN YM. [The Correlates of Nurses' Self-Efficacy for End-of-Life Care] [J]. Hu li za zhi. J Nurs. 2019;66(5):32\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBROGLIO K, BOOKBINDER M. Pilot of an online introduction to palliative care for nurses [J]. J Hospice Palliat Nurs. 2014;16(7):420\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBRAUN M. Associations between oncology nurses' attitudes toward death and caring for dying patients [J]. Oncol Nurs Forum. 2010;37(1):E43\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHENOCH I, DANIELSON E. Training intervention for health care staff in the provision of existential support to patients with cancer: a randomized, controlled study [J]. J Pain Symptom Manage. 2013;46(6):785\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePHILLIPS J, SALAMONSON Y, DAVIDSON PM. An instrument to assess nurses' and care assistants' self-efficacy to provide a palliative approach to older people in residential aged care: a validation study [J]. Int J Nurs Stud. 2011;48(9):1096\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHA E, LEE S, LEE J, et al. Health Personnel's Knowledge, Attitudes, and Self-Efficacy Related to Providing Palliative Care in Persons with Chronic Diseases [J]. Han'guk Hosup'isu Wanhwa Uiryo Hakhoe chi\u0026thinsp;=\u0026thinsp;The. Korean J hospice Palliat care. 2020;23(4):198\u0026ndash;211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKIM JS, KIM J. Knowledge, attitude and self-efficacy towards palliative care among nurses in Mongolia: A cross-sectional descriptive study [J]. PLoS ONE. 2020;15(7):e0236390.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDEFUSCO C, LEWIS A. Improving Critical Care Nurses Perceived Self-Efficacy in Providing Palliative Care: A Quasi-Experimental Study [J]. Am J Hosp Palliat Care. 2023;40(2):117\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSALMANI N, KESHMIRI F, BAGHERI I. The effect of combined training (theoretical-practical) of palliative care on perceived self-efficacy of nursing students [J]. PLoS ONE. 2024;19(7):e0302938.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEAGAR K, SENIOR K, FILDES D et al. The palliative care evaluation tool kit: a compendium of tools to aid in the evaluation of palliative care projects [J]. 2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGUO J, CHEN Y, SHEN B, et al. Translation and validation of the Chinese version of Palliative Care Self-Efficacy Scale [J]. Palliative \u0026amp; supportive care; 2024. pp. 1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMIN Z. Study on status quo of nurses' knowledge andattitudes on palliative care in Shanghai. [D]; Naval Medical University; 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNAKAZAWA Y, MIYASHITA M, MORITA T, et al. The palliative care self-reported practices scale and the palliative care difficulties scale: reliability and validity of two scales evaluating self-reported practices and difficulties experienced in palliative care by health professionals [J]. J Palliat Med. 2010;13(4):427\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXIAOYAN Z, XIUXIU H, QIAOQIN W, et al. Reliability and validity of the Chinese version of the Palliative Care Self-Reported Practices Scale [J]. Chin Nurs Manage. 2021;21(09):1309\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAWAD B, BATRAN A, MALAK M Z, et al. Knowledge, attitudes, and self-efficacy regarding palliative care among Palestinian nurses in intensive care units [J]. BMC Nurs. 2025;24(1):435.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFADAEI S, AZIZZADEH FOROUZI M, MIYASHITA M, et al. Palliative care knowledge and self-efficacy: a comparative study between intensive care units and general units nurses [J]. BMC Palliat care. 2024;23(1):246.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBARNETT M D, REED C M, ADAMS CM. Death Attitudes, Palliative Care Self-efficacy, and Attitudes Toward Care of the Dying Among Hospice Nurses [J]. J Clin Psychol Med Settings. 2021;28(2):295\u0026ndash;300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMEILING L, ZHIQIN L, WANMIN Q. Current status and influencing factors of knowledge, attitude and practice of palliative care among nurses in Tianjin [J]. Tianjin J Nurs. 2023;31(06):631\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLI L, WANG F, LIANG Q, et al. Nurses knowledge of palliative care: systematic review and meta-analysis [J]. BMJ Support Palliat Care; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHOVER-SIERRA E, MART\u0026iacute;NEZ-SABATER A, LAPE\u0026ntilde;A-MO\u0026ntilde;UX Y. Knowledge in palliative care of nursing professionals at a Spanish hospital [J]. Revista latino-americana de enfermagem; 2017. p. 25e2847.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDI G, FAN D, XIAOYA Z, et al. Current status of knowledge, attitude and practice of palliative care among nurses in Beijing general hospitals and its influencing factors [J]. Chin J Mod Nurs. 2021;27(27):3680\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXIAOHAN T, LIMEI J. Survey onattitudeandinfluencingfactors of hospicecareamonghealthprovidersinShanghai [J]. Chin J Gen Practitioners. 2021;20(5):556\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYUJIE R, YUEFEN P, CHENGLIANG W, et al. Research progress of supportive needs of family caregivers of terminally ill patients [J]. Psychologies Magazine. 2025;20(05):237\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSATO K, INOUE Y, UMEDA M, et al. A Japanese region-wide survey of the knowledge, difficulties and self-reported palliative care practices among nurses [J]. Jpn J Clin Oncol. 2014;44(8):718\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKUDUBES A A, MURAT BEKTAS R, DIJLE AYAR R, et al. Palliative care difficulties and psychometric properties of the Turkish version of the self-esteem based palliative care practice scale [J]. Int J Caring Sci. 2019;12(1):162\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGIBBS K D JR, MAHON M M, TRUSS M, et al. An Assessment of Hospital-Based Palliative Care in Maryland: Infrastructure, Barriers, and Opportunities [J]. J Pain Symptom Manage. 2015;49(6):1102\u0026ndash;8.\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-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Oncology Nurses, Palliative Care Knowledge, Palliative Care Self-Efficacy, Questionnaire Survey","lastPublishedDoi":"10.21203/rs.3.rs-9194676/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9194676/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study aimed to evaluate the current status of palliative care self-efficacy, palliative care knowledge, and self-reported hospice care practices among oncology nurses. In addition, it sought to identify the factors influencing palliative care self-efficacy and to provide a theoretical foundation for developing effective palliative care management strategies for oncology nursing.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional survey was conducted among 381 oncology nurses recruited through convenience sampling from 22 hospitals in Tianjin, China, between February and April 2025. Data were collected using a general information questionnaire, the Palliative Care Self-Efficacy Scale, the Palliative Care Knowledge Quiz, and the Palliative Care Self-Reported Practices Scale.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe mean palliative care self-efficacy score among oncology nurses was 31.80\u0026thinsp;\u0026plusmn;\u0026thinsp;7.69. Self-efficacy was positively correlated with palliative care knowledge (10.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30; r\u0026thinsp;=\u0026thinsp;0.320, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and with self-reported hospice care practice (66.78\u0026thinsp;\u0026plusmn;\u0026thinsp;13.39; r\u0026thinsp;=\u0026thinsp;0.424, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Multivariate linear regression analysis revealed that hospital type, years of nursing experience, experience caring for dying patients, prior hospice care training, level of palliative care knowledge, and self-reported practice scores (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were significant predictors of palliative care self-efficacy.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTargeted interventions addressing these identified factors are recommended to enhance oncology nurses\u0026rsquo; palliative care self-efficacy, thereby improving the quality of hospice care delivered in oncology settings.\u003c/p\u003e","manuscriptTitle":"Self-efficacy of oncology nurses in palliative-care: an Analysis of the current status and influencing factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-01 15:55:16","doi":"10.21203/rs.3.rs-9194676/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-29T08:45:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72000791073489491525926450862430417190","date":"2026-04-09T09:28:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-30T07:02:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-27T18:26:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-25T09:01:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-25T09:01:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-03-23T02:28:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d1c7cb35-8d29-47de-ba68-f0952cb410ba","owner":[],"postedDate":"April 1st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T15:55:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-01 15:55:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9194676","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9194676","identity":"rs-9194676","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}