Abstract
CONTEXT: Global aging and rising chronic disease burden have made hospice and palliative care (HPC) a healthcare priority. China has initiated three rounds of HPC pilot programs covering two-thirds of its cities, yet public utilization remains low. Understanding public knowledge, attitude, and preference (KAP) toward HPC is essential to overcoming adoption barriers and fostering acceptance. OBJECTIVES: To empirically evaluate public KAP for HPC, pinpoint influencing factors, and offer targeted strategies to address challenges. METHODS: This cross-sectional study assessed public KAP using the culturally adapted Public Knowledge, Attitude, and Preference of HPC Scale (P-KAPHPCs). Regression analysis was applied to identify factors associated with KAP. A structural equation model was constructed to test their interrelationship. RESULTS: Among all the respondents, the mean score for HPC knowledge was 7.47 ± 2.14, with 41.10% of the respondents could explain HPC. Educational level and household income were associated factors of knowledge (p < 0.05). The overall attitude mean score rate was 84.18%. Public attitude toward end-of-life (EOL) arrangements for terminally ill patients was significantly influenced by age, attitude toward one's own EOL care were affected by educational level (p < 0.05). The majority (67.80%) declined life-sustaining treatment (LST), with preference linked to gender, occupation, experience of witnessing a patient's EOL process, primary family decision-makers, and family size (p < 0.05). Most respondents (47.30%) preferred home as the place for the EOL care. Structural equation modeling analysis showed that knowledge was positively associated with attitude (β = 4.97, p < 0.001) and knowledge was positively associated with preference (β = 0.22, p < 0.001). CONCLUSIONS: The public attitude toward HPC is generally positive, though there is a need to improve the quality of public knowledge, and preference varies. Knowledge has a positive influence on both attitude and preference. Traditional cultural values and ethics sometimes create conflicts in HPC decision-making. Therefore, it is recommended to strengthen HPC education, enhance legal protections for advance care planning (ACP) and advance directives (AD), introduce culturally appropriate family consensus communication tools, and establish a home-community hybrid care model.