Palliative care knowledge and attitudes toward end-of-life care among clinical nurses across healthcare settings in Guangzhou, China: a cross-sectional study

Despite growing global recognition of palliative care’s importance, access to adequately trained professionals and high-quality services remains highly unequal across countries. Nurses’ knowledge and attitudes are critical determinants of end-of-life care quality, yet evidence from diverse institutional settings in China remains limited. This study aimed to assess palliative care knowledge and attitudes toward end-of-life care among nurses in Guangzhou, China, and to identify the key factors influencing these attitudes. This cross-sectional study recruited 1196 registered nurses from 17 institutions across seven administrative districts of Guangzhou between January 2019 and June 2023 using convenience sampling. Data were collected using a general information questionnaire, the Palliative Care Quiz for Nursing (PCQN), and the Frommelt Attitudes Toward Care of the Dying Scale Form-B (FATCOD-B). Multiple linear regression was performed to identify independent predictors of attitudes toward end-of-life care. The sample included nurses from tertiary general ( n = 424, 35.5%), oncology ( n = 359, 30.0%), and community hospitals ( n = 413, 34.5%). The overall PCQN accuracy rate was 53.2%, with the highest correct rate in the domain of “pain and other symptom control” (60.5%) and the lowest in “psychosocial support” (29.7%). The mean FATCOD-B score was 99.63 ± 8.56. Community hospital nurses scored lower on both knowledge and attitude measures. Multiple linear regression identified four independent predictors of end-of-life care attitudes: higher PCQN scores were associated with more positive attitudes (B = 5.593, P = 0.033); perceiving palliative care training as unnecessary was associated with less positive attitudes (B = − 5.620, P < 0.001); an ordinary (vs. harmonious) relationship with patients’ families was associated with less positive attitudes (B = − 1.565, P = 0.009); and working in community hospitals was associated with lower FATCOD-B scores than working in tertiary general hospitals (B = − 1.641, P = 0.007). Nurses’ palliative care knowledge was inadequate and attitudes toward end-of-life care remained suboptimal, particularly among nurses working in community hospitals. These findings underscore the need for systematic, institutionally tailored palliative care education and training, especially in community settings, to improve palliative care knowledge and foster more positive attitudes toward end-of-life care.