Attitudes of registered nurses toward palliative and end-of-life care in Macao: a cross-sectional study in an east-meets-west context

Abstract

Nurses' attitudes toward palliative and end-of-life care may affect communication with patients and families, symptom support, and willingness to provide care for dying patients. Evidence from Macao remains limited despite its ageing population and healthcare context shaped by Chinese cultural traditions and Western medical practice. A descriptive cross-sectional study was conducted from June to August 2021 in the main public hospital in Macao. Registered nurses completed an anonymous online questionnaire containing demographic/professional items and the Chinese version of the Frommelt Attitude Toward Care of the Dying scale. Negatively worded FATCOD items were reverse-coded before total scores were calculated. Welch tests, Bonferroni post-hoc comparisons, effect sizes, and multivariable linear regression with robust standard errors were used. A total of 282 nurses completed the survey. Most were female (88.3%), held a bachelor's degree (75.5%), and had no palliative care training (61.0%). The mean FATCOD score was 110.45 (SD = 8.22), and internal consistency was acceptable (Cronbach's alpha = 0.804). In adjusted analysis, prior palliative care experience was associated with higher FATCOD scores (B = 4.22, robust SE = 1.22, p  < .001). Work unit also remained associated with scores; compared with Surgery, Pediatrics, Internal Medicine, and Orthopedics/Rehabilitation had higher adjusted scores. The model explained 22.6% of the variance. Registered nurses in Macao reported moderately favorable attitudes toward palliative and end-of-life care. Training and experience should be strengthened, but cultural explanations should be interpreted cautiously because cultural beliefs were not directly measured.