Effect of palliative care training on knowledge and self-efficacy of nursing student: a quasi-experimental study

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Despite its importance, nursing students in Iran often lack structured education in palliative care, which may hinder their ability to deliver effective and comprehensive care to individuals facing severe health conditions. To address this gap, the current study aimed to evaluate effect of palliative care training on knowledge and self-efficacy of nursing student in Iran. Method This randomized controlled trial was conducted in 2024 with 70 nursing students recruited through convenience sampling from a hospital in Tehran. Participants were randomly assigned to either an intervention group or a control group. Those in the intervention group attended specialized palliative care workshops, while the control group continued with the standard nursing curriculum. Data were collected both before and after the intervention using two standardized instruments: the Palliative Care Knowledge Test and the Self-Efficacy in Palliative Care Scale. Statistical analyses were conducted to assess differences within and between groups. Results At baseline, no significant difference was found between the intervention and control groups in terms of mean knowledge scores (7.77 ± 3.36 vs. 6.42 ± 2.58; p = 0.06). Similarly, the self-efficacy scores were not significantly different prior to the intervention (1041.00 ± 286.66 vs. 949.85 ± 127.84; p = 0.09). However, post-intervention results showed a significant improvement in the intervention group’s knowledge scores compared to the control group (9.40 ± 2.56 vs. 5.57 ± 2.17; p < 0.001). Additionally, self-efficacy scores in the intervention group increased notably and were significantly higher than those in the control group after the educational intervention (1138.14 ± 221.24 vs. 958.25 ± 149.05; p < 0.001). Conclusion This study showed that workshop training is effective on nursing students' knowledge and self-efficacy in palliative care. Therefore, it is suggested that integrating palliative care training into the undergraduate nursing curriculum should help develop nurses' knowledge and skills in caring for patients with life-threatening conditions . palliative care hospice end of life care nursing student knowledge self-efficacy Introduction In recent years, palliative care has been increasingly recognized as a compassionate, ethical, and person-centered approach to healthcare, aimed at improving the quality of life for individuals with life-limiting conditions and their families. It addresses suffering through the prevention, early identification, and treatment of pain and other physical, psychological, and spiritual problems [1]. The World Health Organization (WHO) classifies palliative care as an essential part of integrated, people-centered health services [1] and emphasizes its importance for both patients and their families [2, 3]. Although an estimated 40 million people globally require palliative care each year, only about 14% actually receive it [4]. This disparity is largely due to the misconception that palliative care is limited to cancer treatment, resulting in insufficient public and professional awareness [4]. Moreover, the increasing aging population, the high prevalence of chronic illnesses, and the growing demands of end-of-life care underscore the need to embed palliative care training within health systems and to prepare competent healthcare providers [5–7]. Iran, like many other countries, faces several healthcare challenges, including rising medical costs, an aging population, and a surge in noncommunicable diseases. According to the 2016 census, 11% of Iran’s population was over the age of 60, with projections suggesting that this figure will reach 25% by 2050 [8, 9]. Despite some advances in family medicine, large segments of the population—especially in rural areas—still lack access to palliative care services [9]. Nurses, as key members of the healthcare team, maintain close, ongoing contact with patients and thus play a vital role in delivering palliative care. Empowering nursing students with education and training in palliative and end-of-life care is critical to ensuring quality service delivery [10]. However, research shows that many nursing students lack sufficient preparation in this area. Several studies have reported inadequate knowledge and limited preparedness among both students and practicing nurses in managing dying patients [11, 12]. Specifically, a study by Alipour et al. highlighted nurses’ limited understanding of palliative care practices [13]. Similarly, Ghaderi (2020) found that low levels of knowledge and attitudes among nurses, as well as poor awareness among families, were major obstacles to effective palliative care [14]. Gazanchai et al. (2020) also pointed out that the primary challenges in implementing palliative care include insufficient resources, inappropriate use of medical technology, organizational barriers, and variations in nurses’ professional competence [15]. Educational interventions have been shown to improve students’ knowledge and foster more positive attitudes toward palliative care [16]. Studies have demonstrated that formal instruction in palliative and end-of-life care can enhance students’ knowledge, skills, confidence, and their ability to provide holistic, patient-centered care [16]. Despite the recognized importance of this training, palliative care content is not systematically integrated into Iran’s nursing curriculum. Often, these concepts are introduced through brief, one- or two-session workshops, which are inadequate for developing meaningful expertise [17]. A key factor related to the effectiveness of palliative care education is self-efficacy—the belief in one’s ability to manage care tasks effectively. In the context of palliative care, self-efficacy refers to a nurse’s confidence in addressing patients’ end-of-life needs, including symptom management and emotional support. It also involves the ability to communicate with families about the dying process and to guide them in accessing available support services [18, 19]. International research has shown that nurses with higher self-efficacy experience lower anxiety levels [20] and are better able to cope with the emotional stress of caring for terminally ill patients [21]. Studies conducted in China (2021) [22] and Uganda (2025) [23] further confirm that self-efficacy plays a pivotal role in shaping nurses’ attitudes and responses to palliative care challenges. In response to evolving societal expectations and professional standards, nursing education is shifting toward a more person- and family-centered model that spans all stages of life. Accordingly, palliative care is increasingly recognized as a core component of nursing education, essential for ensuring high-quality healthcare outcomes [24, 25]. In Iran, however, the palliative care system is still developing, and existing research highlights a lack of awareness, insufficient education, and limited expertise among healthcare providers [26, 27]. Despite detailed nursing curricula, palliative care training for students remains minimal and fragmented, often limited to isolated workshops [28]. This lack of comprehensive instruction presents a major barrier to building the necessary knowledge and self-efficacy among future nurses. Therefore, the present study was conducted to examine the effect of palliative care training on the knowledge and self-efficacy of nursing students in Iran. Methods Research design This quasi-experimental research utilized a pre- and post-test format involving two comparable groups—one receiving the intervention and the other serving as a control. The aim was to assess the impact of palliative care education on the knowledge and self-efficacy of nursing students in Iran during 2024. The study was duly recorded in the Iranian Registry of Clinical Trials under the identification number IRCT20241001063228N1. Setting and participants The study was conducted in a teaching hospital in Tehran. A total of 70 undergraduate nursing students from the 5th to 8th semesters were recruited through convenience sampling. Participants were then randomly assigned to either the intervention or control group using block randomization with blocks of four. Inclusion criteria consisted of: willingness to participate, completion of at least two semesters of clinical training in a hospital setting, successful completion of at least 80% of theoretical coursework, and a cumulative GPA of 14 or higher. Exclusion criteria included: Withdrawal of consent or unwillingness to continue participation, experiencing major physical, psychological, or emotional stressors during the study period, participation in another palliative care-related study, and incomplete attendance in the training sessions. Sample size and sampling methods The required number of participants was estimated based on effect size considerations, drawing on prior research and the study’s design involving pre- and post-intervention assessments with a control group [29–31]. A substantial effect size of 0.8 was anticipated. To accommodate a possible 20% attrition rate, the final sample was set at 35 students per group, resulting in a total of 70 participants. The sample size formula were used as follows: Intervention After obtaining informed consent, participants in both groups completed pre-test questionnaires. The intervention group participated in a structured educational program consisting of four in-person workshops, each lasting between 60 and 90 minutes. The training sessions incorporated diverse teaching strategies such as lectures using slides, group discussions, case-based learning, and hands-on exercises. Attendance in all sessions was mandatory, and student presence was monitored. The control group received no specific instruction related to palliative care during the study. One month after the final workshop, both groups completed the same set of questionnaires to evaluate the impact of the intervention. Content of training sessions Educational Content Development The educational content was designed following an extensive review of relevant literature accessed through multiple academic databases, including Google Scholar, PubMed, Medline, Magiran, Elsevier, and SID. Keywords included: palliative care, education, knowledge, self efficacy nurse, and knowledge. To ensure content validity, a panel of palliative care experts reviewed the proposed session topics. Two main indicators were utilized: the Content Validity Ratio (CVR) and the Content Validity Index (CVI). CVR was calculated using the formula: Ne = number of experts identifying the item as essential; N = total number of experts Topics with CVR values below the threshold from the Lawshe table were excluded. CVI assessed the relevance of each item using a 4-point Likert scale. The CVI was calculated using the formula: Items rated as "relevant but needs revision" or "completely relevant" (scores of 3 and 4) were counted. Items with a CVI < 0.70 were removed, those between 0.70 and 0.79 were revised, and those ≥ 0.80 were accepted. The finalized content was delivered by a palliative care fellowship expert and included: philosophy of palliative care, palliative care models and teamwork, symptom management (e.g., respiratory and gastrointestinal issues), pain assessment and interventions (pharmacologic and non-pharmacologic), psychological, spiritual, social, and religious care, family and bereavement support, concepts of death and dying, and advanced care planning ( Table 1 ). Table 1 Educational content taught in training workshops Session Content Dimension 1 Philosophy of Care, PC definition, addressing patient needs, core principles of palliative care, dimension of PC Teamwork, medication management, intravenous fluid administration, Patient Management, Needs, Medications, IV Therapy Physical 2 Management of respiratory distress, Gastrointestinal Care pain assessment, pain management Physical 3 Psychological support, communication about end-of-life issues, managing delirium, supporting families and addressing bereavement, Psychological Care, End-of-Life Discussions and advance care p0lannnig, anxiety, depression Psychological 4 Interprofessional collaboration, addressing religious needs and fostering hope, spiritual and social support, understanding death and dying processes, Religious Care & Hope, Spiritual & Social Care, Death & Dying Social-Spiritual Data collection instruments Demographic Questionnaire This form gathered basic information including age, gender, marital status, semester of study, clinical experience, prior experience with end-of-life care, race, religion, and employment in a clinical setting. Palliative Care Knowledge Test Originally created by Nakazawa et al. in 2009 [32], this test includes 20 true/false questions covering five domains: philosophy, dyspnea, pain, psychological issues, and gastrointestinal symptoms. The tool was culturally adapted and translated into Persian through a forward and backward translation process. Its reliability was confirmed via a two-week test-retest (r = 0.82), and Internal consistency was measured with Cronbach’s alpha (α = 0.79). The split-half reliability was 0.76, confirming acceptable psychometric properties for use in this study. 3. Palliative Care Self-Efficacy Scale Originally created by Mason et al. in 2004 [33], this scale contains 23 items spanning three domains: communication, patient management, and interprofessional collaboration. Each item is rated from 0 (very anxious) to 100 (very confident). The Persian version was translated using the forward-backward method with permission from the original authors. Test-retest reliability over two weeks yielded a correlation coefficient of 0.85. Cronbach's alpha for the overall scale was 0.91, with subdomain values varying 0.87 to 0.90 across subdomains, confirming high internal consistency. Data analysis Statistical analysis was carried out with SPSS software, version 26. The Kolmogorov–Smirnov test was applied to assess normal data distribution, while Chi-square and Fisher’s exact tests examined categorical variables. Independent t-tests evaluated differences in average knowledge and self-efficacy scores between the intervention and control groups, and paired t-tests were used to measure changes within each group pre- and post-intervention. The significance threshold was set at p < 0.05. The data analyst was blinded to group allocation to reduce bias. Ethical consideration Ethical clearance for the study was obtained from the Ethics Committee of Baqiyatallah University of Medical Sciences (IR.BMSU.REC.1403.007). Prior to participation, all individuals gave both written and verbal informed consent in alignment with the ethical principles outlined in the 2013 Declaration of Helsinki. Participants received comprehensive information regarding the study's objectives, procedures, possible risks, anticipated benefits and data publish. They were assured that their involvement was entirely voluntary, their personal data would remain confidential, and they had the right to withdraw from the study at any point without penalty. The study also upheld strict ethical standards concerning the protection of vulnerable groups, participant safety, and transparent reporting [34]. Result During the study, a total of four participants were excluded—three from the intervention group due to non-participation and voluntary withdrawal, and one from the control group due to withdrawal. Ultimately, the final sample included 70 nursing students, equally divided between the experimental and control groups (35 students each). The participants had a mean age of 23.30 years (SD = 3.67). The majority were male (87.1%), in their sixth academic semester (71.4%), and single (75.7%). Notably, 85.7% had not previously attended any palliative care training workshops. Baseline demographic characteristics—including age, gender, academic term, marital status, prior workshop attendance, and experience caring for a first-degree relative—were comparable across both groups (Table 2 ). Table 2 Baseline Demographic Characteristics Between Intervention and Control Groups Variable Intervention group(n = 35) mean(SD) Control group(n = 35) mean(SD) Test Statistics, df, p-value Age 24.03(4.97) 22.57(1.24) Independent sample t-test T = 1.68 Df = 68 P = 0.098 Gender f (%) f (%) Male 32(52.5) 29(47.5) Chi-Square Tests X2 = 1.14 Df = 1 P = 0.28 female 3(33.3) 6(66.7) Semester f (%) f (%) Sex 26(74.3) 24(68.6) Chi-Square Tests X2 = 0.28 Df = 1 P = 0.59 Eight 9(25.70 11(31.4) Marital f (%) f (%) married 23(65.7) 30(85.7) Chi-Square Tests X2 = 3.80 Df = 1 P = 0.051 Single 12(34.3) 5(14.3) workshop f (%) f (%) Yes 6(17.1) 4(11.4) Chi-Square Tests X 2 = 0.46 Df = 1 P = 0.49 No 29(82.9) 31(88.6) Experiences of caring f (%) f (%) Yes 9(25.7) 10(28.6) Chi-Square Tests X 2 = 0.07 Df = 1 P = 0.78 No 26(74.3) 25(71.4) An independent t-test analysis revealed no significant difference in the baseline "palliative care knowledge" scores between the intervention and control groups (p = .065). However, after the training program, the intervention group exhibited a significant improvement in knowledge compared to the control group (p < 0.001). According to the paired t-test, the control group showed no meaningful change before and after the intervention (p = .079), while the intervention group demonstrated a substantial gain in knowledge (p < 0.001) (Table 3 ). Table 3 Comparison of palliative care knowledge scores between the intervention and control groups Variable Group Pre-intervention Post-intervention P value * Philosophy intervention 1.37 ± 0.73 1.65 ± 0.53 0.03 control 1.02 ± 0.78 0.68 ± 0.63 0.07 P value ** 0.06 0.00 pain intervention 2.34 ± 1.21 2.71 ± 1.31 0.03 control 2.08 ± 1.24 1.71 ± 1.01 0.13 P value ** 0.38 0.001 Respiratory disorders intervention 1.34 ± .93 1.68 ± 1.07 .016 control .91 ± .85 .68 ± .71 .394 P value ** 0.30 0.002 Neuropsychiatric disorders intervention 1.07 ± 1.09 1.34 ± .96 .048 control 1.08 ± 1.12 .91 ± .95 .186 P value ** 0.46 0.002 Gastrointestinal disorders intervention 1.62 ± 1.05 2.00 ± .87 .040 control 1.31 ± .58 1.57 ± .77 .130 P value ** 0.13 0.03 Total knowledge intervention 7.77 ± 3.36 9.40 ± 2.56 .000 control 6.42 ± 2.58 5.57 ± 2.17 .079 P value ** .065 .000 * paired t test ** Independent t-test In the "philosophy" dimension of palliative care, there were no significant differences between the groups at baseline (p = 0.06). Post-intervention, however, the intervention group scored significantly higher (p < 0.001). Within-group analysis showed no notable change for the control group (p = 0.07), whereas the intervention group showed a significant improvement (p = 0.03) (Table 3 ). For "pain management," no statistically significant difference was found before the intervention (p = 0.38), but after the intervention, the intervention group showed a marked improvement (p < 0.001). The paired t-test confirmed that while the control group did not show a significant change (p = 0.13), the intervention group experienced a significant increase in knowledge (p = 0.03) (Table 3 ). Regarding "respiratory disorders," initial scores between the groups were similar (p = 0.30). Post-intervention results showed a significant improvement in the intervention group (p < 0.001). The control group showed no significant change (p = 0.394), whereas the intervention group’s scores improved significantly (p = 0.016) (Table 3 ). In the dimension of "neuropsychiatric disorders," no significant difference was noted between the groups at baseline (p = 0.46), but a statistically significant difference emerged after the intervention (p < 0.001). The paired t-test showed no meaningful change in the control group (p = 0.186), but the intervention group had a significant gain (p = 0.048) (Table 3 ). For "gastrointestinal disorders," the two groups were not significantly different before the intervention (p = 0.13). Although post-intervention comparisons also did not show a significant difference between groups (p = 0.130), the paired t-test revealed that the intervention group improved significantly (p = 0.040), while the control group did not (p = 0.130) (Table 3 ). In terms of self-efficacy, both groups had comparable scores at baseline (p = 0.09), but after the training, the intervention group showed a statistically significant improvement (p < 0.001). The control group’s self-efficacy scores remained unchanged (p = 0.75), while the intervention group’s scores increased notably (p = 0.02) (Table 4 ). Table 4 Comparison of self-efficacy scores between the intervention and control groups Variable Group Pre-training Post-training P value * Communication related to effect of disease intervention 88.42 ± 24.69 98.71 ± 11.39 .033 control 83.28 ± 19.47 82.14 ± 25.47 .842 P value ** 0.33 0.001 Communication related to death intervention 260.28 ± 74.45 278.57 ± 59.41 .051 control 241.71 ± 40.69 231.97 ± 54.14 .285 P value ** 0.20 0.001 Patient management intervention 239.00 ± 75.86 261.71 ± 60.85 .050 control 214.85 ± 26.69 199.14 ± 45.56 .090 P value ** 0.17 0.05 Multidisciplinary team working intervention 453.28 ± 161.73 499.14 ± 138.20 .047 control 410.00 ± 88.21 445.00 ± 89.17 .061 P value ** 0.3 0.002 Total self-efficacy intervention 1041.00 ± 286.66 1138.14 ± 221.24 .020 control 949.85 ± 127.84 958.25 ± 149.05 .756 P value ** 0.09 0.000 * Independent t-test **paired t test Within the "communication about disease effects" dimension, the groups did not differ significantly before the intervention (p = 0.33). However, following the training, the intervention group scored significantly higher (p < 0.001). The control group’s scores stayed the same (p = 0.842), while the intervention group’s scores improved significantly (p = 0.033) (Table 4 ). For the "communication about death" dimension, no significant baseline difference was found (p = 0.20), but a significant post-intervention difference was observed (p < 0.001). The paired t-test revealed no significant change in the control group (p = 0.285), and although the intervention group showed improvement, it was just below the threshold of statistical significance (p = 0.051) (Table 4 ). Lastly, in the "patient management" dimension, the groups did not significantly differ prior to the intervention (p = 0.17). However, post-intervention analysis showed a meaningful improvement in the intervention group (p = 0.05). The control group’s scores remained steady (p = 0.090), while the intervention group experienced a significant increase (p = 0.050) (Table 4 ). Discussion The overall results of the present study showed that palliative care education leads to an improvement in the knowledge and self-efficacy of students. The results also indicate that due to the lack of a separate curriculum for palliative care education in nursing students in Iran, even after the students graduate, there is a weakness in care in this area. Fadaei et al. (2024) showed in their study (35) that the knowledge and self-efficacy of nurses in general and special wards in the field of palliative care are at a low level. The results of their study showed that there is no significant difference between general (p = 0.053) and special wards (p = 0.098) in this regard. The instrument used in this study to measure palliative care knowledge was the Nakazawa questionnaire, as in the present study, but the instrument used to measure self-efficacy was the Palliative Care Self-Efficacy Scale (PCSES), which was developed and used by Phillips et al. (18). Also, the study by Fadaei et al. was conducted on graduate nurses, but the present study was conducted on nursing students in their 6th to 8th semester. The similarity of the results of the two studies above shows the weakness in separate palliative care education for nurses even after graduation. Also, there was no significant difference in the field of palliative care knowledge in the dimensions of Philosophy, pain, respiratory, neuropsychiatric, and gastrointestinal disorders in the two groups (specialty and general nurses). Discussion The findings of the present study clearly demonstrate that structured education in palliative care significantly improves nursing students’ knowledge and self-efficacy. This enhancement underscores a broader issue in Iran's nursing education system—namely, the absence of a dedicated curriculum for palliative care. As a result, both students and practicing nurses may lack the necessary skills and knowledge to provide quality care in this domain, even after graduation. Supporting this concern, Fadaei et al. (2024) found that nurses working in both general and specialized hospital wards exhibited low levels of knowledge and self-efficacy in palliative care (35). Their results indicated no significant difference in knowledge between the two groups (p = 0.053 for general wards and p = 0.098 for specialized wards). While both studies used the Nakazawa Palliative Care Knowledge Test, Fadaei et al. utilized the Palliative Care Self-Efficacy Scale (PCSES) developed by Phillips et al. (18), in contrast to the scale used in the current study. Moreover, Fadaei’s research focused on licensed nurses, whereas our study targeted nursing students in the later stages of their undergraduate training. The consistency in findings across both studies emphasizes a systemic gap in palliative care education, not only at the student level but also among practicing nurses. Furthermore, Fadaei’s research revealed no significant differences in palliative care knowledge across various domains—philosophy, pain management, respiratory, neuropsychiatric, and gastrointestinal symptoms—between general and specialized nurses. In contrast, the present study showed a significant improvement across all domains following the intervention (35). Iranmanesh et al. (2014) also explored palliative care knowledge using the Palliative Care Quiz for Nursing (PCQN). Their results revealed that while nurses performed best in the domain of pain and symptom management (46.07% correct responses), they struggled most with psychosocial and spiritual care (only 19.3% correct) (36). Iranmanesh recommended integrating palliative care education into undergraduate curricula and establishing dedicated palliative care units, aligning closely with the recommendations of our study. Similarly, Afsharizadeh et al. (2022) investigated the knowledge and attitudes of healthcare professionals—comprising general practitioners, oncologists, nurses, and faculty members—toward palliative care using a researcher-developed questionnaire (36). The findings showed that the participants’ knowledge and attitudes were only at an average level, leading the authors to advocate for targeted educational programs. While the participant pool in their study was more diverse than ours, the overall conclusion remains consistent: education in palliative care is insufficient across different professional levels and specialties. In another study, Wijesinghe (2023) conducted a cross-sectional analysis of 200 nurses in Sri Lanka to assess their knowledge and attitudes towards end-of-life care. Using the Palliative Care Knowledge Test (PCKT) and the Frommelt Attitude Toward Care of the Dying Scale, the study found that over half (55%) of nurses had inadequate knowledge of palliative care. However, those with over 10 years of experience or working in surgical wards demonstrated comparatively better knowledge and attitudes. Despite these gaps, the overall attitude towards palliative care was positive, and the author emphasized the need to incorporate palliative care education into nursing curricula—an assertion consistent with our study’s findings (37). Moreover, Shibata et al. (2022) investigated the impact of a six-month educational program on primary palliative care for physicians managing heart failure patients. Using several assessment tools, including the Palliative Care Knowledge Test in HF (PT-HF), they reported significant improvements in knowledge following the intervention (38). Although their study focused on physicians and spanned a longer duration compared to our one-month training for nursing students, the outcomes were similar in that education led to measurable improvements in knowledge. The difference in duration and target population may explain the magnitude of effect; longer training and professional experience often yield more profound learning outcomes. Additionally, differences in measurement instruments could also account for some variation in results. Taken together, these findings from both domestic and international research highlight a shared concern: palliative care education remains insufficient across multiple healthcare roles. This reinforces the need to formally incorporate comprehensive, evidence-based palliative care education into undergraduate nursing programs. Doing so can enhance both the competence and confidence of future healthcare providers, ultimately improving the quality of care for patients with life-limiting illnesses. Conclusion Based on the findings of this study, as well as previous research in the field of palliative care, there is a clear lack of emphasis on palliative and end-of-life care education across most healthcare disciplines—particularly within nursing. A key concern is that students often receive little to no exposure to these critical topics during their academic training. This educational gap contributes to insufficient knowledge and underdeveloped attitudes among graduates when it comes to providing quality palliative care. Considering the growing elderly population and the rising demand for end-of-life care services in modern healthcare systems, integrating a structured palliative care curriculum into nursing programs—and other patient-centered healthcare disciplines—is both timely and essential. Future research should aim to broaden the scope of palliative care education and explore interprofessional training approaches, particularly collaborations between nursing and medical students, to enhance preparedness across the healthcare workforce. Abbreviations Content Validity Ratio (CVR) Content Validity Index (CVI) Palliative Care Quiz for Nursing (PCQN) Palliative Care Self-Efficacy Scale (PCSES) Palliative Care Knowledge Test (PCKT) Palliative Care Knowledge Test in HF (PT-HF) Declarations Ethics approval and consent to participate Ethical clearance for the study was obtained from the Ethics Committee of Baqiyatallah University of Medical Sciences (IR.BMSU.REC.1403.007). Prior to participation, all individuals gave both written and verbal informed consent in alignment with the ethical principles outlined in the 2013 Declaration of Helsinki. Consent for publication Participants received comprehensive information regarding the study's objectives, procedures, possible risks, anticipated benefits and data publish. They were assured that their involvement was entirely voluntary, their personal data would remain confidential, and they had the right to withdraw from the study at any point without penalty. The study also upheld strict ethical standards concerning the protection of vulnerable groups, participant safety, and transparent reporting Availability of data and materials Data and materials are available to the research team. Competing Interests No Competing Interests exist. Funding This research work was carried out with personal funding. Authors' contributions Explain in the cover letter Acknowledgements In this article, we utilized AI to improve readability and enhance the language. We would like to thank all students and faculty members who participated in the project. References (2006). WHOW. WHO definition of palliative care 2006-2024 [Available from: Retrieved from https://www.who.int/cance r/palli ative /defin ition /en/. Alanazi MA, Shaban MM, Ramadan OME, Zaky ME, Mohammed HH, Amer FGM, et al. Navigating end-of-life decision-making in nursing: a systematic review of ethical challenges and palliative care practices. BMC Nursing. 2024;23(1):467482-. 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BMC Palliative Care. 2021;20:1-7. Ashrafizadeh H, Khanali Mojen L, Barasteh S, Akbari ME, Beiranvand S, Shirinabadi Farahani A, et al. Factors Related to Nurses and Physicians’ Knowledge and Attitudes Towards Palliative Care. Int J Cancer Manag. 2022;15(2):e122653. 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. International Journal of Nursing Studies. 2011;48(9):1096-100. Max E, MacKenzie MA. Just in KASE: Evaluating Nursing Students’ Knowledge, Attitudes, and Self-Efficacy Toward Care for the Dying Patients. Journal of Hospice & Palliative Nursing. 2017;19(4). Mystakidou K, Parpa E, Panagiotou, Tsilika E, Galanos A, Gouliamos A. Caregivers' anxiety and self‐efficacy in palliative care. 2013. Limardi S, Stievano A, Rocco G, Vellone E, Alvaro R. Caregiver resilience in palliative care: a research protocol. 2015. Zhou Y, Li Q, Zhang W. Undergraduate nursing students’ knowledge, attitudes and self‐efficacy regarding palliative care in China: A descriptive correlational study. Nursing open. 2021;8(1):343-53. Natuhwera G, Namisango E, Ellis P. Knowledge, Self-Efficacy, and Correlates in Palliative and End-of-Life Care: Quantitative Insights from Final-Year Nursing and Medical Students in a Mixed-Methods Study. Palliative Care and Social Practice. 2025;19:26323524251316901. Durojaiye A, Ryan R, Doody O. Student nurse education and preparation for palliative care: A scoping review. PLoS One. 2023;18(7):e0286678. Rosa WE FB, Mazanec P. Global integration of palliative nursing education to improve health crisis preparedness. Journal of Continuing Education Nursing. 2021;52(3):130-5. Ansari M, Rassouli M, Akbari ME, Abbaszadeh A, Sari AA. Educational needs on palliative care for cancer patients in Iran: A SWOT analysis. International journal of community based nursing and midwifery. 2018;6(2):111. Khoshnazar TA RM, Akbari ME, et al. Structural challenges of providing palliative care for patients with breast cancer. Indian J Palliat Care. 2016;22(66-459). barasteh s, rassouli m, Karimirad M-R, khaghanizadeh m, nasiri M, Soleimani Mohammad M, et al. Overview of Palliative Care Curriculum's for Nursing Students. Bimonthly of Education Strategies in Medical Sciences. 2023;16(3):247-55. Allen Jr JC. Sample size calculation for two independent groups: A useful rule of thumb. Proceedings of Singapore Healthcare. 2011;20(2):138-40. Chow S-C, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research: chapman and hall/CRC; 2017. Cohen J. Statistical power analysis for the behavioral sciences: routledge; 2013. Nakazawa Y, Miyashita M, Morita T, Umeda M, Oyagi Y, Ogasawara T. The palliative care knowledge test: reliability and validity of an instrument to measure palliative care knowledge among health professionals. Palliative medicine. 2009;23(8):754-66. Mason S, Ellershaw J. Assessing undergraduate palliative care education: validity and reliability of two scales examining perceived efficacy and outcome expectancies in palliative care. Medical education. 2004;38(10):1103-10. Association WM. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human participants. JAMA. 2025;333(1):71-4. Fadaei S, Azizzadeh Forouzi M, Miyashita M, Faleh AJ, Dehghan M. Palliative care knowledge and self-efficacy: a comparative study between intensive care units and general units nurses. BMC Palliat Care. 2024;23(1):246. Ashrafizadeh H, Mojen LK, Barasteh S, Akbari ME, Beiranvand S, Farahani AS, et al. Factors Related to Nurses and Physicians' Knowledge and Attitudes Towards Palliative Care. International Journal of Cancer Management. 2022;15(2). Wijesinghe T, Gunathilaka N, Mendis S, Udayanga L. Assessment of knowledge and attitude towards the Palliative Care among nurses in Sri Lanka: A Hospital-based study. Journal of Palliative Care. 2023;38(3):345-54. Shibata T, Oishi S, Mizuno A, Ohmori T, Okamura T, Kashiwagi H, et al. Evaluation of the effectiveness of the physician education program on primary palliative care in heart failure. PLoS One. 2022;17(2):e0263523. Ioshimoto T, Shitara DI, do Prado GF, Pizzoni R, Sassi RH, de Gois AFT. Education is an important factor in end-of-life care: results from a survey of Brazilian physicians' attitudes and knowledge in end-of-life medicine. BMC Med Educ. 2020;20(1):339. Sánchez-Cárdenas MA, Tibaquirá CAN, Mantilla-Manosalva N, Fonseca DA, Morales AM, Delgado MXL. Palliative care education in undergraduate medical and nursing programs in Colombia: a cross-sectional analysis. BMC Palliat Care. 2024;23(1):149. Additional Declarations No competing interests reported. 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It addresses suffering through the prevention, early identification, and treatment of pain and other physical, psychological, and spiritual problems [1]. The World Health Organization (WHO) classifies palliative care as an essential part of integrated, people-centered health services [1] and emphasizes its importance for both patients and their families [2, 3].\u003c/p\u003e\u003cp\u003eAlthough an estimated 40\u0026nbsp;million people globally require palliative care each year, only about 14% actually receive it [4]. This disparity is largely due to the misconception that palliative care is limited to cancer treatment, resulting in insufficient public and professional awareness [4]. Moreover, the increasing aging population, the high prevalence of chronic illnesses, and the growing demands of end-of-life care underscore the need to embed palliative care training within health systems and to prepare competent healthcare providers [5–7].\u003c/p\u003e\u003cp\u003eIran, like many other countries, faces several healthcare challenges, including rising medical costs, an aging population, and a surge in noncommunicable diseases. According to the 2016 census, 11% of Iran’s population was over the age of 60, with projections suggesting that this figure will reach 25% by 2050 [8, 9]. Despite some advances in family medicine, large segments of the population—especially in rural areas—still lack access to palliative care services [9].\u003c/p\u003e\u003cp\u003eNurses, as key members of the healthcare team, maintain close, ongoing contact with patients and thus play a vital role in delivering palliative care. Empowering nursing students with education and training in palliative and end-of-life care is critical to ensuring quality service delivery [10]. However, research shows that many nursing students lack sufficient preparation in this area. Several studies have reported inadequate knowledge and limited preparedness among both students and practicing nurses in managing dying patients [11, 12]. Specifically, a study by Alipour et al. highlighted nurses’ limited understanding of palliative care practices [13]. Similarly, Ghaderi (2020) found that low levels of knowledge and attitudes among nurses, as well as poor awareness among families, were major obstacles to effective palliative care [14]. Gazanchai et al. (2020) also pointed out that the primary challenges in implementing palliative care include insufficient resources, inappropriate use of medical technology, organizational barriers, and variations in nurses’ professional competence [15].\u003c/p\u003e\u003cp\u003eEducational interventions have been shown to improve students’ knowledge and foster more positive attitudes toward palliative care [16]. Studies have demonstrated that formal instruction in palliative and end-of-life care can enhance students’ knowledge, skills, confidence, and their ability to provide holistic, patient-centered care [16]. Despite the recognized importance of this training, palliative care content is not systematically integrated into Iran’s nursing curriculum. Often, these concepts are introduced through brief, one- or two-session workshops, which are inadequate for developing meaningful expertise [17].\u003c/p\u003e\u003cp\u003eA key factor related to the effectiveness of palliative care education is self-efficacy—the belief in one’s ability to manage care tasks effectively. In the context of palliative care, self-efficacy refers to a nurse’s confidence in addressing patients’ end-of-life needs, including symptom management and emotional support. It also involves the ability to communicate with families about the dying process and to guide them in accessing available support services [18, 19]. International research has shown that nurses with higher self-efficacy experience lower anxiety levels [20] and are better able to cope with the emotional stress of caring for terminally ill patients [21].\u003c/p\u003e\u003cp\u003eStudies conducted in China (2021) [22] and Uganda (2025) [23] further confirm that self-efficacy plays a pivotal role in shaping nurses’ attitudes and responses to palliative care challenges. In response to evolving societal expectations and professional standards, nursing education is shifting toward a more person- and family-centered model that spans all stages of life. Accordingly, palliative care is increasingly recognized as a core component of nursing education, essential for ensuring high-quality healthcare outcomes [24, 25].\u003c/p\u003e\u003cp\u003eIn Iran, however, the palliative care system is still developing, and existing research highlights a lack of awareness, insufficient education, and limited expertise among healthcare providers [26, 27]. Despite detailed nursing curricula, palliative care training for students remains minimal and fragmented, often limited to isolated workshops [28]. This lack of comprehensive instruction presents a major barrier to building the necessary knowledge and self-efficacy among future nurses. Therefore, the present study was conducted to examine the effect of palliative care training on the knowledge and self-efficacy of nursing students in Iran.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eResearch design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis quasi-experimental research utilized a pre- and post-test format involving two comparable groups—one receiving the intervention and the other serving as a control. The aim was to assess the impact of palliative care education on the knowledge and self-efficacy of nursing students in Iran during 2024. The study was duly recorded in the Iranian Registry of Clinical Trials under the identification number IRCT20241001063228N1.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSetting and participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study was conducted in a teaching hospital in Tehran. A total of 70 undergraduate nursing students from the 5th to 8th semesters were recruited through convenience sampling. Participants were then randomly assigned to either the intervention or control group using block randomization with blocks of four. Inclusion criteria consisted of: willingness to participate, completion of at least two semesters of clinical training in a hospital setting, successful completion of at least 80% of theoretical coursework, and a cumulative GPA of 14 or higher. Exclusion criteria included: Withdrawal of consent or unwillingness to continue participation, experiencing major physical, psychological, or emotional stressors during the study period, participation in another palliative care-related study, and incomplete attendance in the training sessions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size and sampling methods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe required number of participants was estimated based on effect size considerations, drawing on prior research and the study’s design involving pre- and post-intervention assessments with a control group [29–31]. A substantial effect size of 0.8 was anticipated. To accommodate a possible 20% attrition rate, the final sample was set at 35 students per group, resulting in a total of 70 participants. The sample size formula were used as follows:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e\u003c/p\u003e\u003cp\u003e After obtaining informed consent, participants in both groups completed pre-test questionnaires. The intervention group participated in a structured educational program consisting of four in-person workshops, each lasting between 60 and 90 minutes. The training sessions incorporated diverse teaching strategies such as lectures using slides, group discussions, case-based learning, and hands-on exercises. Attendance in all sessions was mandatory, and student presence was monitored. The control group received no specific instruction related to palliative care during the study. One month after the final workshop, both groups completed the same set of questionnaires to evaluate the impact of the intervention.\u003c/p\u003e\u003cp\u003e\u003cb\u003eContent of training sessions\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eEducational Content Development\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe educational content was designed following an extensive review of relevant literature accessed through multiple academic databases, including Google Scholar, PubMed, Medline, Magiran, Elsevier, and SID. Keywords included: palliative care, education, knowledge, self efficacy nurse, and knowledge.\u003c/p\u003e\u003cp\u003eTo ensure content validity, a panel of palliative care experts reviewed the proposed session topics. Two main indicators were utilized: the Content Validity Ratio (CVR) and the Content Validity Index (CVI). CVR was calculated using the formula:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eNe = number of experts identifying the item as essential; N = total number of experts Topics with CVR values below the threshold from the Lawshe table were excluded. CVI assessed the relevance of each item using a 4-point Likert scale. The CVI was calculated using the formula:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eItems rated as \"relevant but needs revision\" or \"completely relevant\" (scores of 3 and 4) were counted. Items with a CVI \u0026lt; 0.70 were removed, those between 0.70 and 0.79 were revised, and those ≥ 0.80 were accepted. The finalized content was delivered by a palliative care fellowship expert and included: philosophy of palliative care, palliative care models and teamwork, symptom management (e.g., respiratory and gastrointestinal issues), pain assessment and interventions (pharmacologic and non-pharmacologic), psychological, spiritual, social, and religious care, family and bereavement support, concepts of death and dying, and advanced care planning ( Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEducational content taught in training workshops\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSession\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContent\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDimension\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhilosophy of Care, PC definition, addressing patient needs, core principles of palliative care, dimension of PC Teamwork, medication management, intravenous fluid administration, Patient Management, Needs, Medications, IV Therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eManagement of respiratory distress, Gastrointestinal Care pain assessment, pain management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePsychological support, communication about end-of-life issues, managing delirium, supporting families and addressing bereavement, Psychological Care, End-of-Life Discussions and advance care p0lannnig, anxiety, depression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePsychological\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterprofessional collaboration, addressing religious needs and fostering hope, spiritual and social support, understanding death and dying processes, Religious Care \u0026amp; Hope, Spiritual \u0026amp; Social Care, Death \u0026amp; Dying\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial-Spiritual\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection instruments\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDemographic Questionnaire\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis form gathered basic information including age, gender, marital status, semester of study, clinical experience, prior experience with end-of-life care, race, religion, and employment in a clinical setting.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePalliative Care Knowledge Test\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOriginally created by Nakazawa et al. in 2009 [32], this test includes 20 true/false questions covering five domains: philosophy, dyspnea, pain, psychological issues, and gastrointestinal symptoms. The tool was culturally adapted and translated into Persian through a forward and backward translation process. Its reliability was confirmed via a two-week test-retest (r = 0.82), and Internal consistency was measured with Cronbach’s alpha (α = 0.79). The split-half reliability was 0.76, confirming acceptable psychometric properties for use in this study.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3. Palliative Care Self-Efficacy Scale\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOriginally created by Mason et al. in 2004 [33], this scale contains 23 items spanning three domains: communication, patient management, and interprofessional collaboration. Each item is rated from 0 (very anxious) to 100 (very confident). The Persian version was translated using the forward-backward method with permission from the original authors. Test-retest reliability over two weeks yielded a correlation coefficient of 0.85. Cronbach's alpha for the overall scale was 0.91, with subdomain values varying 0.87 to 0.90 across subdomains, confirming high internal consistency.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was carried out with SPSS software, version 26. The Kolmogorov–Smirnov test was applied to assess normal data distribution, while Chi-square and Fisher’s exact tests examined categorical variables. Independent t-tests evaluated differences in average knowledge and self-efficacy scores between the intervention and control groups, and paired t-tests were used to measure changes within each group pre- and post-intervention. The significance threshold was set at p \u0026lt; 0.05. The data analyst was blinded to group allocation to reduce bias.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical consideration\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Ethical clearance for the study was obtained from the Ethics Committee of Baqiyatallah University of Medical Sciences (IR.BMSU.REC.1403.007). Prior to participation, all individuals gave both written and verbal informed consent in alignment with the ethical principles outlined in the 2013 Declaration of Helsinki. Participants received comprehensive information regarding the study's objectives, procedures, possible risks, anticipated benefits and data publish. They were assured that their involvement was entirely voluntary, their personal data would remain confidential, and they had the right to withdraw from the study at any point without penalty. The study also upheld strict ethical standards concerning the protection of vulnerable groups, participant safety, and transparent reporting [34].\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eDuring the study, a total of four participants were excluded—three from the intervention group due to non-participation and voluntary withdrawal, and one from the control group due to withdrawal. Ultimately, the final sample included 70 nursing students, equally divided between the experimental and control groups (35 students each). The participants had a mean age of 23.30 years (SD = 3.67). The majority were male (87.1%), in their sixth academic semester (71.4%), and single (75.7%). Notably, 85.7% had not previously attended any palliative care training workshops. Baseline demographic characteristics—including age, gender, academic term, marital status, prior workshop attendance, and experience caring for a first-degree relative—were comparable across both groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Demographic Characteristics Between Intervention and Control Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention group(n = 35) mean(SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl group(n = 35) mean(SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTest Statistics, df, p-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.03(4.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.57(1.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIndependent sample t-test\u003c/p\u003e\u003cp\u003eT = 1.68\u003c/p\u003e\u003cp\u003eDf = 68\u003c/p\u003e\u003cp\u003eP = 0.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ef (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ef (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32(52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi-Square Tests\u003c/p\u003e\u003cp\u003eX2 = 1.14\u003c/p\u003e\u003cp\u003eDf = 1\u003c/p\u003e\u003cp\u003eP = 0.28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(66.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSemester\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ef (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ef (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26(74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(68.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi-Square Tests\u003c/p\u003e\u003cp\u003eX2 = 0.28\u003c/p\u003e\u003cp\u003eDf = 1\u003c/p\u003e\u003cp\u003eP = 0.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(25.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(31.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ef (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ef (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23(65.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi-Square Tests\u003c/p\u003e\u003cp\u003eX2 = 3.80\u003c/p\u003e\u003cp\u003eDf = 1\u003c/p\u003e\u003cp\u003eP = 0.051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(14.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eworkshop\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ef (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ef (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi-Square Tests\u003c/p\u003e\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e = 0.46\u003c/p\u003e\u003cp\u003eDf = 1\u003c/p\u003e\u003cp\u003eP = 0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29(82.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31(88.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExperiences of caring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ef (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ef (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi-Square Tests\u003c/p\u003e\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e = 0.07\u003c/p\u003e\u003cp\u003eDf = 1\u003c/p\u003e\u003cp\u003eP = 0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26(74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(71.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAn independent t-test analysis revealed no significant difference in the baseline \"palliative care knowledge\" scores between the intervention and control groups (p = .065). However, after the training program, the intervention group exhibited a significant improvement in knowledge compared to the control group (p \u0026lt; 0.001). According to the paired t-test, the control group showed no meaningful change before and after the intervention (p = .079), while the intervention group demonstrated a substantial gain in knowledge (p \u0026lt; 0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of palliative care knowledge scores between the intervention and control groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePost-intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value *\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePhilosophy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.37 ± 0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.65 ± 0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.02 ± 0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.68 ± 0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003epain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.34 ± 1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.71 ± 1.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.08 ± 1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.71 ± 1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eRespiratory disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.34 ± .93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.68 ± 1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.91 ± .85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.68 ± .71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.394\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNeuropsychiatric disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.07 ± 1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.34 ± .96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.08 ± 1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.91 ± .95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.186\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGastrointestinal disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.62 ± 1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.00 ± .87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.040\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.31 ± .58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.57 ± .77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.130\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTotal knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.77 ± 3.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.40 ± 2.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.42 ± 2.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.57 ± 2.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.079\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e* paired t test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e** Independent t-test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn the \"philosophy\" dimension of palliative care, there were no significant differences between the groups at baseline (p = 0.06). Post-intervention, however, the intervention group scored significantly higher (p \u0026lt; 0.001). Within-group analysis showed no notable change for the control group (p = 0.07), whereas the intervention group showed a significant improvement (p = 0.03) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFor \"pain management,\" no statistically significant difference was found before the intervention (p = 0.38), but after the intervention, the intervention group showed a marked improvement (p \u0026lt; 0.001). The paired t-test confirmed that while the control group did not show a significant change (p = 0.13), the intervention group experienced a significant increase in knowledge (p = 0.03) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding \"respiratory disorders,\" initial scores between the groups were similar (p = 0.30). Post-intervention results showed a significant improvement in the intervention group (p \u0026lt; 0.001). The control group showed no significant change (p = 0.394), whereas the intervention group’s scores improved significantly (p = 0.016) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the dimension of \"neuropsychiatric disorders,\" no significant difference was noted between the groups at baseline (p = 0.46), but a statistically significant difference emerged after the intervention (p \u0026lt; 0.001). The paired t-test showed no meaningful change in the control group (p = 0.186), but the intervention group had a significant gain (p = 0.048) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFor \"gastrointestinal disorders,\" the two groups were not significantly different before the intervention (p = 0.13). Although post-intervention comparisons also did not show a significant difference between groups (p = 0.130), the paired t-test revealed that the intervention group improved significantly (p = 0.040), while the control group did not (p = 0.130) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn terms of self-efficacy, both groups had comparable scores at baseline (p = 0.09), but after the training, the intervention group showed a statistically significant improvement (p \u0026lt; 0.001). The control group’s self-efficacy scores remained unchanged (p = 0.75), while the intervention group’s scores increased notably (p = 0.02) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of self-efficacy scores between the intervention and control groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre-training\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePost-training\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value *\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCommunication related to effect of disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.42 ± 24.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98.71 ± 11.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.28 ± 19.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82.14 ± 25.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.842\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCommunication related to death\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e260.28 ± 74.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e278.57 ± 59.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e241.71 ± 40.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e231.97 ± 54.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.285\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePatient management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e239.00 ± 75.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e261.71 ± 60.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e214.85 ± 26.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e199.14 ± 45.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.090\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMultidisciplinary team working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e453.28 ± 161.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e499.14 ± 138.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.047\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e410.00 ± 88.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e445.00 ± 89.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.061\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTotal self-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eintervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1041.00 ± 286.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1138.14 ± 221.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.020\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003econtrol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e949.85 ± 127.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e958.25 ± 149.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.756\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP value\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Independent t-test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e**paired t test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWithin the \"communication about disease effects\" dimension, the groups did not differ significantly before the intervention (p = 0.33). However, following the training, the intervention group scored significantly higher (p \u0026lt; 0.001). The control group’s scores stayed the same (p = 0.842), while the intervention group’s scores improved significantly (p = 0.033) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFor the \"communication about death\" dimension, no significant baseline difference was found (p = 0.20), but a significant post-intervention difference was observed (p \u0026lt; 0.001). The paired t-test revealed no significant change in the control group (p = 0.285), and although the intervention group showed improvement, it was just below the threshold of statistical significance (p = 0.051) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLastly, in the \"patient management\" dimension, the groups did not significantly differ prior to the intervention (p = 0.17). However, post-intervention analysis showed a meaningful improvement in the intervention group (p = 0.05). The control group’s scores remained steady (p = 0.090), while the intervention group experienced a significant increase (p = 0.050) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe overall results of the present study showed that palliative care education leads to an improvement in the knowledge and self-efficacy of students. The results also indicate that due to the lack of a separate curriculum for palliative care education in nursing students in Iran, even after the students graduate, there is a weakness in care in this area. Fadaei et al. (2024) showed in their study (35) that the knowledge and self-efficacy of nurses in general and special wards in the field of palliative care are at a low level. The results of their study showed that there is no significant difference between general (p = 0.053) and special wards (p = 0.098) in this regard. The instrument used in this study to measure palliative care knowledge was the Nakazawa questionnaire, as in the present study, but the instrument used to measure self-efficacy was the Palliative Care Self-Efficacy Scale (PCSES), which was developed and used by Phillips et al. (18). Also, the study by Fadaei et al. was conducted on graduate nurses, but the present study was conducted on nursing students in their 6th to 8th semester. The similarity of the results of the two studies above shows the weakness in separate palliative care education for nurses even after graduation. Also, there was no significant difference in the field of palliative care knowledge in the dimensions of Philosophy, pain, respiratory, neuropsychiatric, and gastrointestinal disorders in the two groups (specialty and general nurses). \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of the present study clearly demonstrate that structured education in palliative care significantly improves nursing students’ knowledge and self-efficacy. This enhancement underscores a broader issue in Iran's nursing education system—namely, the absence of a dedicated curriculum for palliative care. As a result, both students and practicing nurses may lack the necessary skills and knowledge to provide quality care in this domain, even after graduation.\u003c/p\u003e\u003cp\u003eSupporting this concern, Fadaei et al. (2024) found that nurses working in both general and specialized hospital wards exhibited low levels of knowledge and self-efficacy in palliative care (35). Their results indicated no significant difference in knowledge between the two groups (p = 0.053 for general wards and p = 0.098 for specialized wards). While both studies used the Nakazawa Palliative Care Knowledge Test, Fadaei et al. utilized the Palliative Care Self-Efficacy Scale (PCSES) developed by Phillips et al. (18), in contrast to the scale used in the current study. Moreover, Fadaei’s research focused on licensed nurses, whereas our study targeted nursing students in the later stages of their undergraduate training. The consistency in findings across both studies emphasizes a systemic gap in palliative care education, not only at the student level but also among practicing nurses.\u003c/p\u003e\u003cp\u003eFurthermore, Fadaei’s research revealed no significant differences in palliative care knowledge across various domains—philosophy, pain management, respiratory, neuropsychiatric, and gastrointestinal symptoms—between general and specialized nurses. In contrast, the present study showed a significant improvement across all domains following the intervention (35).\u003c/p\u003e\u003cp\u003eIranmanesh et al. (2014) also explored palliative care knowledge using the Palliative Care Quiz for Nursing (PCQN). Their results revealed that while nurses performed best in the domain of pain and symptom management (46.07% correct responses), they struggled most with psychosocial and spiritual care (only 19.3% correct) (36). Iranmanesh recommended integrating palliative care education into undergraduate curricula and establishing dedicated palliative care units, aligning closely with the recommendations of our study.\u003c/p\u003e\u003cp\u003eSimilarly, Afsharizadeh et al. (2022) investigated the knowledge and attitudes of healthcare professionals—comprising general practitioners, oncologists, nurses, and faculty members—toward palliative care using a researcher-developed questionnaire (36). The findings showed that the participants’ knowledge and attitudes were only at an average level, leading the authors to advocate for targeted educational programs. While the participant pool in their study was more diverse than ours, the overall conclusion remains consistent: education in palliative care is insufficient across different professional levels and specialties.\u003c/p\u003e\u003cp\u003eIn another study, Wijesinghe (2023) conducted a cross-sectional analysis of 200 nurses in Sri Lanka to assess their knowledge and attitudes towards end-of-life care. Using the Palliative Care Knowledge Test (PCKT) and the Frommelt Attitude Toward Care of the Dying Scale, the study found that over half (55%) of nurses had inadequate knowledge of palliative care. However, those with over 10 years of experience or working in surgical wards demonstrated comparatively better knowledge and attitudes. Despite these gaps, the overall attitude towards palliative care was positive, and the author emphasized the need to incorporate palliative care education into nursing curricula—an assertion consistent with our study’s findings (37).\u003c/p\u003e\u003cp\u003eMoreover, Shibata et al. (2022) investigated the impact of a six-month educational program on primary palliative care for physicians managing heart failure patients. Using several assessment tools, including the Palliative Care Knowledge Test in HF (PT-HF), they reported significant improvements in knowledge following the intervention (38). Although their study focused on physicians and spanned a longer duration compared to our one-month training for nursing students, the outcomes were similar in that education led to measurable improvements in knowledge. The difference in duration and target population may explain the magnitude of effect; longer training and professional experience often yield more profound learning outcomes. Additionally, differences in measurement instruments could also account for some variation in results.\u003c/p\u003e\u003cp\u003eTaken together, these findings from both domestic and international research highlight a shared concern: palliative care education remains insufficient across multiple healthcare roles. This reinforces the need to formally incorporate comprehensive, evidence-based palliative care education into undergraduate nursing programs. Doing so can enhance both the competence and confidence of future healthcare providers, ultimately improving the quality of care for patients with life-limiting illnesses.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on the findings of this study, as well as previous research in the field of palliative care, there is a clear lack of emphasis on palliative and end-of-life care education across most healthcare disciplines\u0026mdash;particularly within nursing. A key concern is that students often receive little to no exposure to these critical topics during their academic training. This educational gap contributes to insufficient knowledge and underdeveloped attitudes among graduates when it comes to providing quality palliative care. Considering the growing elderly population and the rising demand for end-of-life care services in modern healthcare systems, integrating a structured palliative care curriculum into nursing programs\u0026mdash;and other patient-centered healthcare disciplines\u0026mdash;is both timely and essential. Future research should aim to broaden the scope of palliative care education and explore interprofessional training approaches, particularly collaborations between nursing and medical students, to enhance preparedness across the healthcare workforce.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eContent Validity Ratio (CVR)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eContent Validity Index (CVI)\u003c/p\u003e\n\u003cp\u003ePalliative Care Quiz for Nursing (PCQN)\u003c/p\u003e\n\u003cp\u003ePalliative Care Self-Efficacy Scale (PCSES)\u003c/p\u003e\n\u003cp\u003ePalliative Care Knowledge Test (PCKT)\u003c/p\u003e\n\u003cp\u003ePalliative Care Knowledge Test in HF (PT-HF)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical clearance for the study was obtained from the Ethics Committee of Baqiyatallah University of Medical Sciences (IR.BMSU.REC.1403.007). Prior to participation, all individuals gave both written and verbal informed consent in alignment with the ethical principles outlined in the 2013 Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eParticipants received comprehensive information regarding the study's objectives, procedures, possible risks, anticipated benefits and data publish. They were assured that their involvement was entirely voluntary, their personal data would remain confidential, and they had the right to withdraw from the study at any point without penalty. The study also upheld strict ethical standards concerning the protection of vulnerable groups, participant safety, and transparent reporting\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eData and materials are available to the research team.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eNo Competing Interests exist.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research work was carried out with personal funding.\u003c/p\u003e\n\u003cp\u003eAuthors' contributions\u003c/p\u003e\n\u003cp\u003eExplain in the cover letter\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eIn this article, we utilized AI to improve readability and enhance the language. We would like to thank all students and faculty members who participated in the project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e(2006). WHOW. 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Evaluation of the effectiveness of the physician education program on primary palliative care in heart failure. PLoS One. 2022;17(2):e0263523.\u003c/li\u003e\n\u003cli\u003eIoshimoto T, Shitara DI, do Prado GF, Pizzoni R, Sassi RH, de Gois AFT. Education is an important factor in end-of-life care: results from a survey of Brazilian physicians' attitudes and knowledge in end-of-life medicine. BMC Med Educ. 2020;20(1):339.\u003c/li\u003e\n\u003cli\u003eS\u0026aacute;nchez-C\u0026aacute;rdenas MA, Tibaquir\u0026aacute; CAN, Mantilla-Manosalva N, Fonseca DA, Morales AM, Delgado MXL. Palliative care education in undergraduate medical and nursing programs in Colombia: a cross-sectional analysis. BMC Palliat Care. 2024;23(1):149.\u003c/li\u003e\n\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-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"palliative care, hospice, end of life care, nursing student, knowledge, self-efficacy","lastPublishedDoi":"10.21203/rs.3.rs-7109770/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7109770/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePalliative care is a vital aspect of holistic healthcare, demanding that nurses possess adequate knowledge and confidence to deliver compassionate, patient-centered support. Despite its importance, nursing students in Iran often lack structured education in palliative care, which may hinder their ability to deliver effective and comprehensive care to individuals facing severe health conditions. To address this gap, the current study aimed to evaluate effect of palliative care training on knowledge and self-efficacy of nursing student in Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis randomized controlled trial was conducted in 2024 with 70 nursing students recruited through convenience sampling from a hospital in Tehran. Participants were randomly assigned to either an intervention group or a control group. Those in the intervention group attended specialized palliative care workshops, while the control group continued with the standard nursing curriculum. Data were collected both before and after the intervention using two standardized instruments: the Palliative Care Knowledge Test and the Self-Efficacy in Palliative Care Scale. Statistical analyses were conducted to assess differences within and between groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nAt baseline, no significant difference was found between the intervention and control groups in terms of mean knowledge scores (7.77 ± 3.36 vs. 6.42 ± 2.58; p = 0.06). Similarly, the self-efficacy scores were not significantly different prior to the intervention (1041.00 ± 286.66 vs. 949.85 ± 127.84; p = 0.09). However, post-intervention results showed a significant improvement in the intervention group’s knowledge scores compared to the control group (9.40 ± 2.56 vs. 5.57 ± 2.17; p \u0026lt; 0.001). Additionally, self-efficacy scores in the intervention group increased notably and were significantly higher than those in the control group after the educational intervention (1138.14 ± 221.24 vs. 958.25 ± 149.05; p \u0026lt; 0.001).\u003cbr\u003e\n \u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study showed that workshop training is effective on nursing students' knowledge and self-efficacy in palliative care. Therefore, it is suggested that integrating palliative care training into the undergraduate nursing curriculum should help develop nurses' knowledge and skills in caring for patients with life-threatening conditions\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e","manuscriptTitle":"Effect of palliative care training on knowledge and self-efficacy of nursing student: a quasi-experimental study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-26 06:46:44","doi":"10.21203/rs.3.rs-7109770/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-09-17T11:42:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-20T18:09:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5724906465122272137125698204751849927","date":"2025-08-19T05:35:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270842122536772211655641602745672347228","date":"2025-08-18T17:21:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T14:26:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301922288666561512802848267773378729139","date":"2025-08-18T14:05:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-18T13:52:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-05T05:07:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-04T13:57:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-04T13:53:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e433598f-0bd0-4678-87cd-5ff34c0f830d","owner":[],"postedDate":"August 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-26T06:46:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-26 06:46:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7109770","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7109770","identity":"rs-7109770","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}