Original Article

Knowledge and attitudes toward palliative care and their association among nurses and physicians at a secondary referral hospital in Oman: A cross-sectional study

Abstract

Background & Aim: Providing comprehensive, holistic care is a fundamental goal of healthcare systems, and palliative care constitutes an essential component of such care. Nurses' and physicians' attitudes may influence the integration of palliative care into routine clinical practice. This study aimed to characterize nurses' and physicians' knowledge of and attitudes toward palliative care, assess the relationship between these variables, and identify factors independently associated with attitudes in a secondary referral hospital in Oman.
Methods & Materials: A cross-sectional descriptive correlational study was conducted among 280 nurses and physicians recruited through convenience sampling from clinical departments at Nizwa Hospital, Oman. Data were collected using a demographic questionnaire and the Health Care Providers' Knowledge and Attitude of Palliative Care Questionnaire. Descriptive statistics, nonparametric tests, Spearman's rank-order correlation, and hierarchical multiple linear regression were performed using IBM SPSS Statistics version 26.0.
Results: The mean attitude and knowledge scores were 140.20 ± 13.47 and 18.60 ± 4.11, respectively. Knowledge and attitude scores showed a statistically significant, positive, moderate correlation (rₛ = 0.348, p < 0.001). In the final hierarchical regression model, higher knowledge scores were independently associated with higher attitude scores (β = 0.353, p < 0.001), and the model accounted for 21.0% of the variance in attitude scores.
Conclusion: Knowledge was positively and moderately associated with attitudes toward palliative care, and this association persisted after adjustment for the examined variables. These findings may inform educational planning at the study hospital; however, given the cross-sectional design, they do not establish that higher knowledge leads to more favorable attitudes or improved quality of care. The effectiveness of educational programs should be evaluated in intervention studies.

1. Khanali-Mojen L, Akbari ME, Ashrafizadeh H, Barasteh S, Beiranvand S, Eshaghian-Dorcheh A, et al. Caregivers' Knowledge of and Attitude towards Palliative Care in Iran. Asian Pac J Cancer Prev. 2022;23(11):3743-51.
2. World Health Organization (WHO). Integrating palliative care and symptom relief into primary health care: A WHO guide. Geneva: WHO Press. 2020 [Available from: Retrieved from https://www.who.int/news-room/fact-sheets/detail/palliative-care (2020, accessed 21 December 2025).
3. Krakauer EL, Kwete XJ, Rassouli M, Arreola-Ornelas H, Ashrafizadeh H, Bhadelia A, et al. Palliative care need in the Eastern Mediterranean Region and human resource requirements for effective response. PLOS Global Public Health. 2023;3(11):e0001980.
4. International Agency for Research on Cancer. Global Cancer Observatory: Cancer Today—Oman fact sheet. World Health Organization. 2026 [Available from: https://gco.iarc.who.int/today/en/fact-sheets-populations/512/oman.
5. Sánchez-Cárdenas MA, Garralda E, Steijn DV, Pourghazian N, Slama S, Bouësseau MC, et al. Development of an atlas of palliative care in the Eastern Mediterranean Region through a stakeholder participative process. East Mediterr Health J. 2022;27(8):614-21.
6. Gafer N, Tripodoro V, Suarez D, Montero Calero Á, Garralda-Domezain E, Bastos F, et al. Atlas of Palliative Care Developments in the Eastern Mediterranean Countries2025.
7. Al-Azri M, Al-Saidi S, Al-Musilhi J, Al-Mandhari Z, Panchatcharam SM. Knowledge and Experiences of Final Year Medical and Nursing Students with Regard to Palliative Care at Government University in Oman: A Questionnaire-Based Study. Journal of cancer education: the official journal of the American Association for Cancer Education. 2021;36(4):747-54.
8. Ashrafizadeh H, Mojen L, Barasteh S, Akbari M, Beiranvand S, Farahani A, et al. Factors Related to Nurses and Physicians’ Knowledge and Attitudes Towards Palliative Care. Int J Cancer Manag. 2022;15.
9. World Health Organization. Integrating palliative care and symptom relief into primary health care: A WHO guide for planners, implementers and managers. Geneva: World Health Organization. WHO publication 2018 [
10. World Health Organization Regional Office for the Eastern Mediterranean. Summary report on the expert meeting to develop a regional roadmap for palliative care in the Eastern Mediterranean Region. Cairo: WHO Regional Office for the Eastern Mediterranean. WHO EMRO report. 2019.
11. Muliira JK, Lazarus ER, Mirafuentes EC. A Countrywide Assessment of Omani Undergraduate Nursing Students' Palliative Care Knowledge and Attitudes Towards End-of-Life Care. J Cancer Educ. 2023;38(3):781-8.
12. Lazarus ER, Muliira JK, Al-Zaabi O, Al-Khabori MK, Al Adawi MM, Al Mamari Q. Palliative care knowledge and attitudes towards end-of-life care of nurses in tertiary hospitals. Curationis. 2025;48(1):e1-e9.
13. Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13(Suppl 1):S31-S4.
14. Cohen J. A power primer. Psychol Bull. 1992;112(1):155-60.
15. He X, Cai H, Zhang J, Chen W, Zhu B. Knowledge, Attitude, and Practice of Palliative Care Among Physicians and Nurses in Intensive Care Units in Shanghai, China. J Multidiscip Healthc. 2025;18:2441-9.
16. Weng XR, Nakdali R, Almoosawi B, Al Saeed M, Maiser S, Al Banna M. Health Care Providers' Attitudes and Beliefs on Providing Palliative Care to Patients in Bahrain: Findings From a Qualitative Study. J Pain Symptom Manage. 2021;62(1):98-106.e1.
17. Xie Y, Cai T, Zhu A, Zhang X, Xu C, Song L. Attitudes toward caring for terminally ill patients among community nurses in Shanghai: A cross-sectional study. Int J Nurs Sci. 2025;12(4):401-7.
18. 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.
19. Jawish N, Bohsas H, Swed S, Alibrahim H, Sawaf B, Khair Eldien Jabban Y, et al. Syrian Health Providers' Knowledge of Palliative Care: An Online Cross‑Sectional Study in Syria. Int J Med Stud. 2023;10:S166.
20. AlDrees A, AlSalem S, AlDrees O, AlHaddad A. Current Knowledge, Attitudes, and Practices of Home Health Care Among Primary Health Care Physicians in Al-Ahsa, Saudi Arabia: A Cross-Sectional Study. Cureus. 2025;17(9):e91598.
21. Wejdan Y, Hamza A, Ruqayya Z, Ayman H-M. Status and correlates of attitudes towards end-of-life care among nursing students. Nurs Pract Today. 2022;9(2).
22. Alexandra M, Nassikhat N, Gulmira D. Primary care nurses’ knowledge of palliative care, attitude towards caring for dying patients, and their relationship with evidence-based practice. Nurs Pract Today. 2024;11(2).
23. Adeyemi OJ, Bouillon-Minois JB, Siman N, Cuthel AM, Goldfeld KS, Grudzen CR. Knowledge and Attitudes Toward Hospice and Palliative Care: Instrument Validation Among Emergency Providers. Am J Hosp Palliat Care. 2023;40(3):280-90.
24. Granat L, Andersson S, Åberg D, Hadziabdic E, Sandgren A. Evaluation of the Swedish Self-Efficacy in Palliative Care Scale and exploration of nurses' and physicians' self-efficacy in Swedish hospitals: A cross-sectional study. Scand J Caring Sci. 2024;38(3):568-78.
25. Martín-Martín J, López-García M, Medina-Abellán MD, Beltrán-Aroca CM, Martín-de-Las-Heras S, Rubio L, et al. Physicians' and Nurses' Knowledge in Palliative Care: Multidimensional Regression Models. Int J Environ Res Public Health. 2021;18(9).
26. Biswas J, Banik PC, Ahmad N. Physicians’ knowledge about palliative care in Bangladesh: A cross-sectional study using digital social media platforms. PLoS One. 2021;16(9):e0256927.
27. Hasni NA, Yahyaei AA, Omari OA, Muliira J, Lazarus ER, Riyami NA, et al. Oncology nurses at the frontline of palliative care: knowledge, attitudes, and factors associated with palliative care practice. BMC Health Serv Res. 2025;25(1):1634.
28. Arisanti N, Sasongko EPS, Pandia V, Hilmanto D. Implementation of palliative care for patients with terminal diseases from the viewpoint of healthcare personnel. BMC Res Notes. 2019;12(1):217.
IssueArticles in Press QRcode
SectionOriginal Article(s)
Keywords
palliative care; nurses; physicians; attitudes; knowledge
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Said Alhakmani SM, Rassouli M, Ashrafizadeh H, Maramg Turringan O, Said Al Touby S. Knowledge and attitudes toward palliative care and their association among nurses and physicians at a secondary referral hospital in Oman: A cross-sectional study. Nurs. pract. today. 2026;:X-X.