Palliative care attitude and knowledge among Syrian residents: a cross-sectional study from a conflict-affected country

Palliative care is a patient-centered approach that aims to improve the quality of life of patients with incurable illnesses. It addresses physical symptoms, psychological distress, social challenges, and spiritual concerns. In spite of increasing demand for palliative care recently, numerous studies have demonstrated that healthcare professionals often possess insufficient knowledge in this field. We aim in this study to assess palliative care knowledge among Syrian residents and determine associated factors. A multi-institutional, cross-sectional study was conducted in April 2026 at the Damascus University hospitals. Residents from the following specialties (surgery, internal medicine, anesthesia, oncology, and psychology) were included. We used the Palliative Care Knowledge Test to assess knowledge about palliative care in addition to questions about demographic characteristics, previous training, and attitude towards palliative care. 224 participants were included, with a mean age of 27.32 years and female predominance (52.7%). Most participants were in their second year of residency and were from internal medicine. Only 23.2% of participants reported prior training. Among those, the majority received training during residency (63.4%). Nearly all participants (98.2%) considered palliative care an important subject, and 90.6% expressed interest in further learning. Participants demonstrated variable knowledge across different domains of the scale. The highest level of knowledge was observed in the philosophy domain, with a correct response rate of 93.6%, followed by pain management (44.5%) and the dyspnea domain (36%). Psychiatric aspects (50.1%) and gastrointestinal issues (42.9%) were also observed. The vast majority of the respondents (62%) fall into the lower performance categories (low and very low scores), highlighting significant gaps in technical palliative care competency. Statistical analysis demonstrated that academic seniority, medical specialty, and previous training were significant factors in knowledge levels. In contrast, subjective factors such as the perceived importance of the field, interest in further learning, self-reported preparedness, and having prior clinical experience with terminally ill patients did not correlate with objective knowledge. We highlight in this study a cornerstone issue that can affect patients’ quality of life, patients’ families’ satisfaction, and doctors’ self-estimation. Formal, diligent steps forward in establishing a curriculum in the undergraduate and residency programs are important.