Knowledge and Attitude of Nurses Regarding Palliative Care: A Cross-Sectional Study of Various Tertiary Care Hospitals, Peshawar, Pakistan

Abstract

Background: Palliative care improves quality of life across the disease trajectory, yet misconceptions and attitudinal barriers among nurses can delay timely referral, undermine analgesic stewardship, and impair end-of-life communication. Local data from tertiary hospitals in Pakistan are limited. Objective: To quantify nurses’ knowledge and attitudes toward palliative care in tertiary hospitals of Peshawar and identify priority domains for education. Methods: A cross-sectional survey (June–August 2025) was administered to registered nurses with ≥3 months’ experience across four tertiary hospitals. A structured questionnaire adapted from validated tools captured demographics and item-level agreement on knowledge and attitudes using five-point Likert responses. Descriptive statistics and Wilson 95% confidence intervals were reported for agreement prevalences. Results: Of 262 respondents, 94.8% were female and 61.0% were aged 25–35 years; 43.5% had 1–5 years’ experience and 85.1% held a nursing diploma. Evidence-aligned beliefs were common: educating families (89.6% agreement, 95% CI 85.3–92.7), facilitating patient emotional expression (86.4%, 81.7–90.0), trusting patient self-report of pain (81.8%, 76.7–86.0), and distinguishing chronic from acute pain (81.8%, 76.7–86.0). However, misconceptions were frequent: changing the topic when asked “Am I dying?” (78.6%, 73.2–83.1), perceiving emotional detachment as required (63.7%, 57.7–69.3), limiting palliative care to downhill deterioration (57.8%, 51.7–63.6), endorsing placebo use for pain (66.3%, 60.4–71.8), and preferring intramuscular opioids (48.7%, 42.7–54.7). Conclusion: Nurses demonstrated strong family-centred orientations but substantial gaps in communication and analgesic ethics, defining a tractable training agenda focused on serious-illness dialogue, scope and timing of palliative care, and WHO-concordant pain management.