Exploring the Global Landscape of Nurses' Knowledge, Attitude and Competence in Palliative Care: A Scoping Review

  • Ayu Hardanti School of Nursing, Master Program, Universitas Muhammadiyah Yogyakarta, Indonesia
  • Erna Rochmawati School of Nursing, Universitas Muhammadiyah Yogyakarta, Indonesia
DOI: https://doi.org/10.56338/mppki.v9i4.9138
Keywords: Attitude, Competency, Knowledge, Nurses, Palliative Care

Abstract

Introduction: In palliative care, nurses have essential roles in addressing complex needs of patients with palliative care needs that include physical, psychological, social and spiritual needs. Knowledge and competence are deeply interconnected, as both are critical to provide quality care to patients with life-limiting conditions. However, a comprehensive exploration of nurses’ knowledge, attitude and competence in palliative care across regions remains lacking. The aim of this scoping is to systematically  map the existing evidence regarding palliative care knowledge, attitude and competence  among nurses.

Method: This review followed scoping review framework from Arskey and O’Malley. The PCC framework (population, concept and context) was applied; Population – nurse; Concept- knowledge, competence and attitude; and Context – palliative care. A  comprehensive search was conducted in several data bases: PubMed, SCOPUS, Science Direct, and ProQuest. The search criteria were restricted to studies published in English between 2000 and 2024. Thematic analysis was used to map themes.

Results: Thirty studies were included in  review, demonstrate a consistent pattern of nurses’ insufficient knowledge and self-perceived competence in palliative care, particularly in psychological and spiritual domains. Across studies, assessment approaches were methodologically homogeneous, with a predominant reliance on cross-sectional designs and self-administered instruments. The Palliative Care Knowledge Test (PCKT)) and the Palliative Care Quiz for Nurses (PCQN emerged as the most frequently used tools to measure knowledge, while the Palliative Care Nursing Self-Competence Scale was commonly employed to assess competence.

Conclusion: The review identified nurses’ knowledge ranged from  low to moderate with lower competence reported in specific   areas such as spiritual care. The findings emphasized the need to equip nurses with adequate knowledge and competencies in palliative care to ensure  quality care for patients and  family caregivers in palliative care setting.

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References

  1. Soper K, Reilly M, Krenzer B. The Impact of Embedding a Palliative Care Advance Practice Provider on a Neuroscience Intensive Care Unit Service. J Nurse Pract. 2023;19(4).Available from: https://10.1016/j.nurpra.2023.104542
  2. Balvínová A, Mi?ková M, Nováková L, Hrdli?ková L. Parallel role of a nurse in pediatric oncology setting and palliative care team Professional and competency challenges in the care of children with cancer. Onkologie (Czech Republic). 2022;16(2):71-3.Available from: https://10.36290/XON.2022.013
  3. Brant J, Fink RM. Role of the nurse in the palliative care community. Palliative Care for Chronic Cancer Patients in the Community: Global Approaches and Future Applications2020. p. 39-48.
  4. Llerena Cruz CA, Ramírez Gavilanes GI, Morales Mayorga SG, Simbaña Quishpi MA. The role of nursing in palliative care: a literature review. Sapienza. 2022;3(3):124-37.Available from: https://10.51798/sijis.v3i2.398
  5. Uslu ?ahan F, Terzio?lu F. Evidence-based approaches in palliative care nursing. Anestezi Dergisi. 2017;25(3):30-6.Available
  6. Hökkä M, Martins Pereira S, Pölkki T, Kyngäs H, Hernández-Marrero P. Nursing competencies across different levels of palliative care provision: A systematic integrative review with thematic synthesis. Palliat Med. 2020;34(7):851-70.Available from: https://10.1177/0269216320918798
  7. He X, Li B, Liu X, Jiao P, Zhao Y. Correlation between hospice competence and death coping ability among nursing students in China: A cross-sectional survey. Nurse Educ Today. 2024;134.Available from: https://10.1016/j.nedt.2023.106080
  8. Achora S, Labrague LJ. An Integrative Review on Knowledge and Attitudes of Nurses Toward Palliative Care: Implications for Practice. Jpn J Clin Oncol 2019;21(1):29-37.Available from: https://10.1097/NJH.0000000000000481
  9. Li L, Wang F, Liang Q, Lin L, Shui X. Nurses knowledge of palliative care: systematic review and meta-analysis. BMJ Supportive & Palliative Care. 2024;14(e2):e1585.Available from: https://10.1136/spcare-2022-004104
  10. Parajuli J, Hupcey J. A Systematic Review on Oncology Nurses' Knowledge on Palliative Care. Cancer Nurs. 2021;44(5):E311-E22.Available from: https://10.1097/NCC.0000000000000817
  11. Arskey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32.Available from: https://10.1080/1364557032000119616
  12. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-73.Available from: https://10.7326/m18-0850
  13. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101.Available from: https://10.1191/1478088706qp063oa
  14. Altarawneh WM, Masa'deh R, Hamaideh SH, Saleh AM, Alhalaiqa F. Nurses' knowledge, attitudes and practices towards palliative care provided to patients diagnosed with cancer. PloS one. 2023;18(10):e0289317.Available from: https://10.1371/journal.pone.0289317
  15. Scheinberg-Andrews C, Ganz FD. Israeli Nurses' Palliative Care Knowledge, Attitudes, Behaviors, and Practices. Oncol Nurs Forum. 2020;47(2):213-21.Available from: https://10.1188/20.Onf.213-221
  16. Albanesi B, Piredda M, Marchetti A, Mastroianni C, Magnani C, Artico M, et al. Oncology and Palliative Care Nurses' Knowledge and Attitudes Toward Artificial Nutrition and Hydration for Patients at End of Life in Italy: A Cross-sectional Survey. Cancer nursing. 2021;44(2):E99-e107.Available from: https://10.1097/ncc.0000000000000803
  17. Etafa W, Wakuma B, Fetensa G, Tsegaye R, Abdisa E, Oluma A, et al. Nurses' knowledge about palliative care and attitude towards end- of-life care in public hospitals in Wollega zones: A multicenter cross-sectional study. PloS one. 2020;15(10):e0238357.Available from: https://10.1371/journal.pone.0238357
  18. Kurnia TA, Trisyani Y, Prawesti A. The relationship between nurses' knowledge and self-confidence in implementing palliative care in an intensive care unit. Int J Palliat Nurs. 2020;26(4):183-90.Available from: https://10.12968/ijpn.2020.26.4.183
  19. Getie A, Wondmieneh A, Mengesha A, Fitwi A, Gedefaw G, Demis A. Assessment of Knowledge and Attitude towards Palliative Care and Associated Factors among Nurses Working in North Wollo Hospitals. Ethiop J Health Sci. 2021;31(2):393-400.Available from: https://10.4314/ejhs.v31i2.22
  20. Martínez-Sabater A, Chover-Sierra P, Chover-Sierra E. Spanish Nurses’ Knowledge about Palliative Care. A National Online Survey. Int J Environ Res Public Health. 2021;18(21):11227.Available
  21. 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 palliative care. 2024;23(1):246.Available from: https://10.1186/s12904-024-01580-7
  22. Kim S, Lee K, Kim S. Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study. BMC palliative care. 2020;19(1):105.Available from: https://10.1186/s12904-020-00581-6
  23. Wilson O, Avalos G, Dowling M. Knowledge of palliative care and attitudes towards nursing the dying patient. Br J Nurs. 2016;25(11):600-5.Available from: https://10.12968/bjon.2016.25.11.600
  24. Razban F, Iranmanesh S, Rafiei H. Nurses' attitudes toward palliative care in south-east Iran. Int J Pall Nurs. 2013;19(8):403-10.Available
  25. Nakazawa Y, Kato M, Miyashita M, Morita T, Kizawa Y. Changes in Nurses' Knowledge, Difficulties, and Self-reported Practices Toward Palliative Care for Cancer Patients in Japan: An Analysis of Two Nationwide Representative Surveys in 2008 and 2015. J Pain Symptom Manage. 2018;55(2):402-12.Available from: https://10.1016/j.jpainsymman.2017.08.034
  26. Sato K, Inoue Y, Umeda M, Ishigamori I, Igarashi A, Togashi S, et al. A Japanese region-wide survey of the knowledge, difficulties and self-reported palliative care practices among nurses. Jpn J Clin Oncol 2014;44(8):718-28.Available from: https://10.1093/jjco/hyu075
  27. Pérez-Ros P, Cauli O, Julián-Rochina I, Long CO, Chover-Sierra E. Level of Knowledge and Attitudes Towards Palliative Care for People with Advanced Dementia in Spain: Role of Professional and Academic Factors. Current Alzheimer research. 2022;19(11):785-94.Available from: https://10.2174/1567205020666221221145259
  28. Eleke C, Azuonwu G, Agu IS, Nnorom RM, Ogini AN, Eleke-Bempong E, et al. Knowledge of palliative care among professional nurses in south east Nigeria: A needs assessment for continuing education. Int J Afr Nurs Sci. 2020;13:100237.Available from: https://https://doi.org/10.1016/j.ijans.2020.100237
  29. Do?an R, Do?an A, Karasu F, Ba?ci N. Evaluation of Surgical Clinic Nurses’ Knowledge Levels About Palliative Surgery. American Journal of Hospice and Palliative Medicine®. 2024;41(2):133-9.Available from: https://10.1177/10499091231170084
  30. White L, Agbana S, Connolly M, Larkin P, Guerin S. Palliative care competencies and education needs of nurses and healthcare assistants involved in the provision of supportive palliative care. Int J Palliat Nurs. 2021;27(4):195-204.Available from: https://10.12968/ijpn.2021.27.4.195
  31. Sawatzky R, Roberts D, Russell L, Bitschy A, Ho S, Desbiens JF, et al. Self-Perceived Competence of Nurses and Care Aides Providing a Palliative Approach in Home, Hospital, and Residential Care Settings: A Cross-Sectional Survey. Can J nurs res. 2021;53(1):64-77.Available from: https://10.1177/0844562119881043
  32. Abu-Saad Huijer H, Dimassi H, Abboud S. Perspectives on palliative care in Lebanon: knowledge, attitudes, and practices of medical and nursing specialties. Palliat Support Care. 2009;7(3):339-47.Available from: https://10.1017/s1478951509990277
  33. Pan HH, Shih HL, Wu LF, Hung YC, Chu CM, Wang KY. Path modeling of knowledge, attitude and practice toward palliative care consultation service among Taiwanese nursing staff: a cross-sectional study. BMC palliative care. 2017;16(1):42.Available from: https://10.1186/s12904-017-0228-6
  34. Kassa H, Murugan R, Zewdu F, Hailu M, Woldeyohannes D. Assessment of knowledge, attitude and practice and associated factors towards palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia. BMC palliative care. 2014;13(1):6.Available from: https://10.1186/1472-684x-13-6
  35. Hamdan KM, Al-Bashaireh AM, Al-Dalahmeh M, Saifan AR, Albqoor MA, Shaheen AM. Palliative care knowledge and attitudes toward end-of-life care among intensive care unit nurses in Jordan. Acute Crit Care. 2023;38(4):469-78.Available from: https://10.4266/acc.2023.00430
  36. Nguyen LT, Yates P, Osborne Y. Palliative care knowledge, attitudes and perceived self-competence of nurses working in Vietnam. Int J Palliat Nurs. 2014;20(9):448-56.Available from: https://10.12968/ijpn.2014.20.9.448
  37. Al-Kindi SG, Zeinah GFA, Hassan AA. Palliative Care Knowledge and Attitudes Among Oncology Nurses in Qatar. Am J Hosp Palliat Care. 2014;31(5):469-74.Available from: https://10.1177/1049909113489874
  38. Saleh AM, Alrawaili SM, El-Sakhawy MA, Abdelbasset WK. The Knowledge of Palliative Care among Geriatric Home Staff in Jordan. Afr Health Sci. 2022;22(3):233-40.Available from: https://10.4314/ahs.v22i3.25
  39. Shen Y, Nilmanat K, Promnoi C. Palliative Care Nursing Competence of Chinese Oncology Nurses and Its Related Factors. J Hosp Palliat Nurs. 2019;21(5):404-11.Available from: https://10.1097/njh.0000000000000581
  40. Vu HTT, Nguyen LH, Nguyen TX, Nguyen TTH, Nguyen TN, Nguyen HTT, et al. Knowledge and Attitude Toward Geriatric Palliative Care among Health Professionals in Vietnam. Int J Environ Res Public Health. 2019;16(15).Available from: https://10.3390/ijerph16152656
  41. Chover-Sierra E, Martínez-Sabater A, Lapeña-Moñux Y. Knowledge in palliative care of nursing professionals at a Spanish hospital. Rev Lat Am Enfermagem. 2017;25:e2847.Available from: https://10.1590/1518-8345.1610.2847
  42. Sesma-Mendaza A, Aranguren-Sesma M, Estraviz-Pardo F, Lizarazu-Armendáriz E, Goñi-Viguria R. Nurses' knowledge about palliative care in a critical care unit. Enferm Intensiva (Engl Ed). 2022;33(4):197-205.Available from: https://10.1016/j.enfie.2021.10.003
  43. Iranmanesh S, Razban F, Tirgari B, Zahra G. Nurses' knowledge about palliative care in Southeast Iran. Palliat Support Care. 2014;12(3):203-10.Available from: https://10.1017/S1478951512001058
  44. Ross MM, McDonald B, McGuinness J. The palliative care quiz for nursing (PCQN): the development of an instrument to measure nurses' knowledge of palliative care. J Adv Nurs. 1996;23(1):126-37.Available from: https://10.1111/j.1365-2648.1996.tb03106.x
  45. Hertanti NS, Wicaksana AL, Effendy C, Kao CY. Palliative Care Quiz for Nurses-Indonesian Version (PCQN-I): A Cross-cultural Adaptation, Validity, and Reliability Study. Indian J Palliat Care. 2021;27(1):35-42.Available from: https://10.4103/ijpc.Ijpc_76_20
  46. 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. Palliat Med. 2009;23(8):754-66.Available from: https://10.1177/0269216309106871
  47. Mengual TE, Chover-Sierra E, Ballestar-Tarín ML, Saus-Ortega C, Gea-Caballero V, Colomer-Pérez N, et al. Knowledge about Palliative Care and Attitudes toward Care of the Dying among Primary Care Nurses in Spain. Healthcare (Basel). 2023;11(7).Available from: https://10.3390/healthcare11071018
  48. Soikkeli-Jalonen A, Stolt M, Hupli M, Lemetti T, Kennedy C, Kydd A, et al. Instruments for assessing nurses' palliative care knowledge and skills in specialised care setting: An integrative review. J Clin Nurs. 2020;29(5-6):736-57.Available from: https://10.1111/jocn.15146
  49. Li L, Wang F, Liang Q, Lin L, Shui X. Nurses knowledge of palliative care: systematic review and meta-analysis. BMJ Support Palliat Care. 2023.Available from: https://10.1136/spcare-2022-004104
  50. Kang K-A, Chun J, Kim HY, Kim H-Y. Hospice palliative care nurses’ perceptions of spiritual care and their spiritual care competence: A mixed-methods study. J Clin Nurs. 2021;30(7-8):961-74.Available from: https://https://doi.org/10.1111/jocn.15638
  51. Rochmawati E, Wiechula R, Cameron K. Current status of palliative care services in Indonesia: a literature review. Int Nurs Rev 2016;63(2):180-90.Available from: https://https://doi.org/10.1111/inr.12236
  52. Anita A, Septian RB, Ghozali L. Nurses’ Roles and Challenges in Interprofessional Home-Based Palliative Care: A Systematic Review of Qualitative Studies. American Journal of Hospice and Palliative Medicine. 2025.Available from: https://10.1177/10499091251371145
  53. Bainbridge D, Bishop V, Myers J, Marshall D, Stajduhar K, Seow H. Effectiveness of Training Programs About a Palliative Care Approach: A Systematic Review of Intervention Trials for Health Care Professionals. J Palliat Med. 2023;26(4):564-81.Available from: https://10.1089/jpm.2022.0051
  54. DeSanto-Madeya S, Darcy AMG, Barsamian J, Anderson A, Sullivan L. An innovative application of end-of-life nursing education consortium curriculum to increase clinical nurses' palliative care knowledge. J Hosp Palliat Nurs. 2020;22(5):377-82.Available from: https://10.1097/NJH.0000000000000674
  55. Jack EN, Ingwu JA, Onorikpori TO, Ezekiel R, Amachree DM, Pius VT. Effect of Palliative Care Education on Nurses’ Knowledge of Palliative Care among Hospital-Based Nurses in Tertiary Hospital, Rivers State. Afr J Biomedical Res. 2023;26(3):363-8.Available from: https://10.4314/ajbr.v26i3.9
  56. Manning J, Creel A, Jones N. Effectiveness of an End-of-Life Nursing Education Consortium Training on Registered Nurses' Educational Needs in Providing Palliative and End-of-Life Patient Care. J Hosp Palliat Nurs. 2021;23(1):84-8.Available from: https://10.1097/NJH.0000000000000710
  57. Benner P. From novice to expert. Am J Nurs. 1982;82(3):402-7.Available
Published
2026-04-02
How to Cite
Hardanti, A., & Rochmawati, E. (2026). Exploring the Global Landscape of Nurses’ Knowledge, Attitude and Competence in Palliative Care: A Scoping Review. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 9(4), 848-864. https://doi.org/10.56338/mppki.v9i4.9138
Issue
Vol. 9 No. 4 (2026)
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Article

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