Abstract
Background: Nursing students should be prepared for the provision of palliative care (PC) for patients with terminal cancer. However, few studies have examined factors influencing nursing students' intention. This study aimed to examine the associations between characteristics, knowledge, attitude, experience and their intention to provide PC among Thai nursing students.
Methods: This cross-sectional study was conducted among nursing students enrolled in all four years of the Bachelor of Nursing Science Program at one Nursing College in Bangkok, Thailand. Data were collected using a questionnaire composed of demographic characteristics, The Palliative Care Quiz for Nursing (PCQN), The Frommelt Attitude Toward Care of the Dying (FATCOD) form B and The Nurse's Intention for Providing Palliative Care. Multivariate logistic regression analysis was conducted to examine the associations between related factors and outcome variables.
Results: Among 430 nursing students were female (93.72%). The mean age was 22.00 ± 2.71. Low monthly allowance (AOR 1.84, 95%CI: 1.13-2.97), Buddhist (AOR 2.01, 95%CI: 1.21-3.33), and positive attitudes (AOR 5.44, 95%CI: 1.13-26.04) were the significant predictors of the intention to provide PC.
Conclusion: To enhance the optimum quality of PC provision, it is necessary to cultivate more positive attitudes to increase intention, while integrating religious beliefs into nursing practice. Some strategies such as interdisciplinary learning and encouraging spiritual awareness intervention as well as emphasizing PC training to improve attitude should be integrated in nursing core curricula.
Keywords: Palliative care, nursing students, attitudes, knowledge, behavioral intention, Thailand
Recommended Citation
Prachyakoon N, Hounnaklang N, Win N, Tantirattanakulchai P.
Association Between Characteristics, Experiences, Knowledge, Attitudes, and Intention to Provide Palliative Care for Patients with Terminal Cancer Among Thai Nursing Students: A Cross-sectional Study.
J Health Res.
2026;
40(1):-.
DOI: https://doi.org/10.56808/2586-940X.1178
References
[1] Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396(10258):1204—22. https://doi.org/10.1016/S0140-6736(20)30925-9.
[2] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(3):209—49. https://doi.org/10.3322/caac.21660.
[3] World Health Organization [WHO]. WHO definition of palliative care. 2006 [Updated 2025; Cited 2025 May 27] Available from: https://www.who.int/health-topics/palliative-care.
[4] Schroeder K, Lorenz K. Nursing and the future of palliative care. Asia Pac J Oncol Nurs 2018;5(1):4—8. https://doi.org/10.4103/apjon.apjon_43_17.
[5] Ajzen I. From intentions to actions: a theory of planned behavior. In: Kuhl J, Beckmann J, editors. Action control: from cognition to behavior. Berlin, Heidelberg: Springer Berlin Heidelberg; 1985. p. 11—39. https://doi.org/10.1007/978-3-642-69746-3_2.
[6] Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process 1991;50(2):179211. https://doi.org/10.1016/0749-5978(91)90020-T.
[7] Ben Natan M, Makhoul Khuri M, Hammer H, Yarkoni M. Nursing students' intention to work in hospice care in the future: a cross-sectional study. J Hosp Palliat Nurs 2024;26(2): E55—61. https://doi.org/10.1097/NJH.0000000000000990.
[8] Alrasheedi O, Schultz TJ, Harvey G. Factors influencing nurses' intention to work in the oncology specialty: multiinstitutional cross-sectional study. BMC Palliat Care 2021; 20(1):72. https://doi.org/10.1186/s12904-021-00764-9.
[9] Dimoula M, Kotronoulas G, Katsaragakis S, Christou M, Sgourou S, Patiraki E. Undergraduate nursing students' knowledge about palliative care and attitudes towards endof-life care: a three-cohort, cross-sectional survey. Nurse Educ Today 2019;74:7—14. https://doi.org/10.1016/j.nedt.2018.11.025.
[10] Aboshaiqah AE. Predictors of palliative care knowledge among nursing students in Saudi Arabia: a cross-sectional study. J Nurs Res 2020;28(1):e60. https://doi.org/10.1097/jnr.0000000000000301.
[11] Kim JS, Kim J, Gelegjamts D. Knowledge, attitude and self efficacy towards palliative care among nurses in Mongolia: a cross-sectional descriptive study. PLoS One 2020;15(7): e0236390. https://doi.org/10.1371/journal.pone.0236390.
[12] Zhou Y, Li Q, Zhang W. Undergraduate nursing students' knowledge, attitudes and self-efficacy regarding palliative care in China: a descriptive correlational study. Nurs Open 2021;8(1):343—53. https://doi.org/10.1002/nop2.635.
[13] 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 Palliat Care 2020;19(1):105. https://doi.org/10.1186/s12904-020-00581-6.
[14] Mutto EM, Errazquin A, Rabhansl MM, Villar MJ. Nursing education: the experience, attitudes, and impact of caring for dying patients by undergraduate Argentinian nursing students. J Palliat Med 2010;13(12):1445—50. https://doi.org/10.1089/jpm.2010.0301.
[15] Lo Iacono C, Amodio E, Vella G, Caruso M, D'Anna G, Gambera A, et al. Self-perceived competencies and attitudes on palliative care in undergraduate nursing students: a multicenter descriptive study. Nurs Rep 2024;14(3): 2550—64. https://doi.org/10.3390/nursrep14030188.
[16] 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. https://doi.org/10.12968/bjon.2016.25.11.600.
[17] Zahran Z, Hamdan KM, Hamdan-Mansour AM, Allari RS, Alzayyat AA, Shaheen AM. Nursing students' attitudes towards death and caring for dying patients. Nurs Open 2022; 9(1):614—23. https://doi.org/10.1002/nop2.1107.
[18] Xue B, Cheng Q, Yue SW, Zhao ZH, Wang R, Redding SR, et al. Attitudes and knowledge of palliative care of Chinese undergraduate nursing students: a multicenter crosssectional study. Nurse Educ Today 2023;122:105720. https://doi.org/10.1016/j.nedt.2023.105720.
[19] Wang L, Chen J, Du Y, Wang Z, Li Z, Dong Z. Factors influencing Chinese nursing students' attitudes toward the care of dying patients. J Hosp Palliat Nurs 2017;19(4):343—50. https://doi.org/10.1097/NJH.0000000000000353.
[20] Buddhaghosacariya S Buddhadhamma. The laws of nature and their benefits to life. Buddhadhamma Foundation; 2019 [Updated 2025; Cited 2025 Nov 18] Available from: https://www.thailandfoundation.or.th/wp-content/uploads/2021/09/Buddhadhamma.pdf.
[21] Ranse K, Ranse J, Pelkowitz M. Third-year nursing students' lived experience of caring for the dying: a hermeneutic phenomenological approach. Contemp Nurse 2018;54(2): 160—70. https://doi.org/10.1080/10376178.2018.1461572.
[22] Head B, Middleton A, Zeigler C. Work satisfaction among hospice and palliative nurses. J Hosp Palliat Nurs 2019;21(5): E1—11. https://doi.org/10.1097/NJH.0000000000000562.
[23] Sirisub P, Suwannapong N, Tipayamongkholgul M, Howteerakul N, Noree T. Intention to extend working life among Thai registered nurses in ministry of public health: a national survey. Nurs Res Pract 2019;2019:7919404. https://doi.org/10.1155/2019/7919404.
[24] Conner M, Norman P. Understanding the intentionbehavior gap: the role of intention strength. Front Psychol 2022;13:923464. https://doi.org/10.3389/fpsyg.2022.923464.
[25] Conner M, Wilding S, Norman P. Does intention strength moderate the intention-health behavior relationship for Covid-19 protection behaviors? Ann Behav Med 2024;58(2): 92—9. https://doi.org/10.1093/abm/kaad062.
[26] Medical Service Department, Bangkok metropolitan administration. [Updated 2024; Cited 2025 May 27] Available from: https://webportal.bangkok.go.th/msdbangkok/page/sub/27930.
[27] Prachyakoon N, Hounnaklang N, Win N, Tantirattanakulchai P. Exploring the factors related to knowledge of palliative care for patients with terminal cancer among nursing students: a cross-sectional study. Intern J Nurs Educ 2024;16(4):33—40. https://doi.org/10.37506/s6s5ca80.
[28] Cochran WG. Sampling techniques. 3rd ed. New York: John Wiley & Sons; 1977.
[29] 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. https://doi.org/10.4314/ejhs.v31i2.22.
[30] 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. https://doi.org/10.1111/j.1365-2648.1996.tb03106.x.
[31] Frommelt KH. Attitudes toward care of the terminally ill: an educational intervention. Am J Hosp Palliat Care 2003;20(1): 13—22. https://doi.org/10.1177/104990910302000108.
[32] Frommelt KH. The effects of death education on nurses' attitudes toward caring for terminally ill persons and their families. Am J Hosp Palliat Care 1991;8(5):37—43. https://doi.org/10.1177/104990919100800509.
[33] Zhu Y, Yang B, Li X, Wu B, Guo Q, XuL, et al. Development of the nurses' willingness to engage in palliative care scale. J Hosp Palliat Nurs 2022;24(6):E258—64. https://doi.org/10.1097/NJH.0000000000000898.
[34] Boniol M, Kunjumen T, Nair TS, Siyam A, Campbell J, Diallo K. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and 'universal' health coverage? BMJ Glob Health 2022;7(6). https://doi.org/10.1136/bmjgh-2022-009316.
[35] Wen T, Zhang Y, Wang X, Tang G. Factors influencing turnover intention among primary care doctors: a crosssectional study in Chongqing, China. Hum Resour Health 2018;16(1):10. https://doi.org/10.1186/s12960-018-0274-z.
[36] Al Hadid LAE, Al Barmawi MA, Alnjadat R, Farajat LA. The impact of stress associated with caring for patients with COVID-19 on career decisions, resilience, and perceived self-efficacy in newly hired nurses in Jordan: a crosssectional study. Health Sci Rep 2022;5(6):e899. https://doi.org/10.1002/hsr2.899.
[37] Quince TA, Parker RA, Wood DF, Benson JA. Stability of empathy among undergraduate medical students: a longitudinal study at one UK medical school. BMC Med Educ 2011;11:90. https://doi.org/10.1186/1472-6920-11-90.
[38] Cunico L, Sartori R, Marognolli O, Meneghini AM. Developing empathy in nursing students: a cohort longitudinal study. J Clin Nurs 2012;21(13—14):2016—25. https://doi.org/10.1111/j.1365-2702.2012.04105.x.
[39] Masel EK, Schur S, Watzke HH. Life is uncertain. death is certain. Buddhism and palliative care. J Pain Symptom Manag 2012;44(2):307—12. https://doi.org/10.1016/j.jpainsymman.2012.02.018.
[40] Matchim Y, Raetong P. Thai nursing students' experiences of caring for patients at the end of life: a phenomenological study. Int J Palliat Nurs 2018;24(5):220—9. https://doi.org/10.12968/ijpn.2018.24.5.220.
[41] Khadro S. Preparing for death and helping the dying. 2003 [Updated 2025; Cited 2025 Nov 15] Available from: https://thubtenchodron.org/wp-content/uploads/2024/08/Preparing-for-Death-and-Helping-the-Dying-VSK.pdf.
[42] Chimluang J, Thanasilp S, Akkayagorn L, Upasen R, Pudtong N, Tantitrakul W. Effect of an intervention based on basic Buddhist principles on the spiritual well-being of patients with terminal cancer. Eur J Oncol Nurs 2017;31: 46—51. https://doi.org/10.1016/j.ejon.2017.08.005.
[43] Pokpalagon P, Chaiviboontham S, Phinitkhajorndech N. Spiritual needs,spiritualwell-being,andBuddhistpracticesof patients with terminal illness, Thailand. Palliat Support Care 2024;22(4):718—25. https://doi.org/10.1017/S1478951522001286.
[44] Apiradee Lin CY, Wirojratana V, Lin PC, Shu BC. Nurses' intention and attitude to participate in advance care planning: an extended theory of planned behaviour using structural equation modelling—A cross-sectional study. J Clin Nurs 2025;34(4):1364—74. https://doi.org/10.1111/jocn.17220.
[45] Huang LC, Tung HJ, Lin PC. Associations among knowledge, attitudes, and practices toward palliative care consultation service in healthcare staffs: a cross-sectional study. PLoS One 2019;14(10):e0223754. https://doi.org/10.1371/journal.pone.0223754.