Frommelt Attitude Toward Research Articles

Exploring the Factors Related to Knowledge of Palliative Care for Patients with Terminal Cancer Among Nursing Students: A Cross-Sectional Study

Introduction: The inadequate knowledge is the main obstacle of provision of palliative care. This study attempted to examine the association between related factors and knowledge about palliative care for patients with terminal cancer among nursing students in Bangkok, Thailand. Methods: This study was cross-sectional, conducted in June 2024 at Saint Louis College, Bangkok, Thailand. Data were collected through self-administered questionnaires measuring sociodemographic characteristics. We employed the Palliative Care Quiz for Nursing (PCQN) and the Frommelt Attitude Toward Care of the Dying (FATCOD), form B. Descriptive statistics and multiple linear regression were selected to use for analysis. Results: The participants were 111 third-year nursing students. The mean score of knowledge about palliative care for patients with terminal cancer was 8.52 (SD = 1.84. The significant predictors of knowledge about palliative care for patient with terminal cancer were experience of losing close relatives or beloved ones from cancer within 1 year (β = 1.083, p < 0.05), and attitude toward dying (β = 0.041, p < 0.05). Conclusion: This study highlights that nursing students had insufficient palliative care knowledge for patient with end-stage cancer. These findings implies that better attitude toward caring for end-of-life patient associated with improved palliative care knowledge. Therefore, to develop educational program of palliative care for nursing students with psychological and spiritual care training should be embedded in the program for optimum palliative care for patients with terminal cancer.

Self-Perceived Competencies and Attitudes on Palliative Care in Undergraduate Nursing Students: A Multicenter Descriptive Study.

Introduction: Caring for the dying can generate anxiety and emotional distress, particularly in nursing students, and perceived competence could play a crucial role in enabling nurses to perform their duties with greater confidence. Unfortunately, few studies describe the relationship between students' nursing attitudes and perceived self-efficacy in palliative care (PC). To overcome this gap, this survey aimed to assess the attitudes towards dying patients and the perceived competence of nursing students in palliative care at different universities in the south of Italy. Methods: A cross-sectional study was conducted from September 2022 to March 2023 involving nursing students from the three major Sicilian universities (Italy). The study included a survey investigating socio-demographic characteristics, palliative care training, knowledge about pain management, and previous experience with dying. Moreover, the Professional Competence of the Core Curriculum in Palliative Care Nursing (CCPCN) questionnaire and the Frommelt Attitudes Toward Care of the Dying-B Italian version (FATCOD-B-I) assessed competencies and emotional attitudes. Results: A total of 1913 nursing students were recruited, of which 71.3% were females, and 53.9% were in the age range of 18 to 21 years. In the multivariable analysis, practical PC training was a substantial factor in enhancing competencies (Adj-OR 2.78 [95% CI = 2.12-3.65]). Male students had higher competence odds (Adj-OR 1.38 [95% CI = 1.14-1.66]), and perceived knowledge strongly correlated with self-assessed competence. Advancement in academic years also positively influenced competence self-assessment (Adj-OR 1.98 [95% CI = 1.75-2.24]). Regarding emotional attitudes, a per-quartile increase in competence score was found to improve the attitude score (Adj-OR 1.24 [95% CI = 1.13-1.35]). Conclusions: Nursing students gain valuable experience during clinical experience. PC training and perceived knowledge of PC significantly increase nurses' competencies, and the latter seem to be strongly associated with attitudes. Thus, introducing palliative care education into nurses' core curricula could be a way to reduce anxiety and emotional distress in young students.

Nurses' Perception of Caring and Attitudes toward Caring for Dying Patients: Exploring the Relationship Using a Descriptive Cross-Sectional Design.

This study examines the association between nurses' perception of caring and attitudes toward caring for dying patients in end-of-life care units. We used a descriptive cross-sectional design with convenience sampling. Data were collected from May to June 2021 through self-reported questionnaires from 303 Spanish nurses (mean age = 48 years, 78.9% female). Participants completed the Caring Dimension Inventory (CDI-25) and the Frommelt Attitudes Toward Care of the Dying scale. Demographic and training information were collected. Data were analyzed using Stata 16.0. Attitudes toward Care of the Dying Patient were significantly higher in nurses with palliative care training (β = 2.829, p = 0.018) and those who scored higher on the psychosocial (β = 0.789, p = 0.0001) and technical dimensions (β = 0.487, p = 0.011) of the CDI-25. Multivariate analysis identified the psychosocial dimension of the CDI-25 scale (β = 0.783, p = 0.0001) and palliative care training (β = 2.686, p = 0.017) as the only significant variables associated with Attitudes toward Care of the Dying Patient. Overall, nurses exhibited a positive attitude toward caring for dying patients. Our results could potentially help nursing directors identify those with the necessary qualities and training for optimal end-of-life care and to further plan training courses to provide optimal care in end-of-life situations.

Examining nurses’ death anxiety and attitudes toward caring for dying patients: a cross-sectional study in Turkey

ABSTRACT Death anxiety may reduce the interaction between nurses and patients, causing nurses to focus more on the physical care needs of patients and ignore their psychosocial and spiritual needs. This study was conducted to examine nurses’ death anxiety and attitudes toward caring for dying patients. The data were collected using an information form, the Thorson-Powell Death Anxiety Scale (TPDAS), and the Frommelt Attitudes Toward the Care of the Dying Scale (FATCOD). The mean TPDAS and FATCOD scores were 46.71 (14.48) and 104.97 (13.55), respectively, and it was determined that they had moderate death anxiety and positive attitudes towards the care of dying patients. Those working in intensive care and internal medicine clinics had more positive attitudes toward caring for dying patients compared with those working in surgical clinics. Those who reported having a strong faith had lower death anxiety.

Video training of nursing home healthcare workers in palliative care

ObjectivesThe provision of palliative care in nursing homes (NHs) is of paramount importance, a realism underscored by the frailty and medical complexity of the residents. However, palliative care (PC) education...

The Effect of a Repeated Standardized Patient-Based End-of-Life Care Training Program on Nursing Students' Knowledge, Attitudes, and Emotions Toward End-of-Life Patients.

Sufficient knowledge of end-of-life care, positive attitudes, and emotions regarding death and dying are essential criteria for showcasing favorable palliative care educational results to undergraduate nursing students. However, nursing students have negative attitudes toward end-of-life care and know little about it. This study aimed to examine the effect of a repeated standardized patient-based training program (intervention) on nursing students' knowledge, attitudes, and emotions about end-of-life patients. This study adopted a pretest-posttest quasi-experimental research design. The sample consisted of 50 fourth-year nursing students divided into intervention (n = 25) and control (n = 25) groups. All participants attended the intervention. The intervention group attended the intervention twice, while the control group attended it only once. Data were collected using a personal information form, the Frommelt Attitudes Toward Care of the Dying Scale, the Positive and Negative Affect Schedule, and the End-of-Life Care Nursing Questionnaire. The data were analyzed using descriptive statistics, Pearson's Chi-square test, dependent groups t test, Pearson-Spearman, Mann-Whitney test, Wilcoxon test, and Friedman test. The intervention helped participants learn more about end-of-life care (χ2 = 27.167, P = .000; F = 42.725, P = .000) and develop more positive attitudes toward end-of-life patients (F = 13.279, P = .000; F = 6.934, P = .000). The intervention also helped participants develop communication skills. Universities should integrate repeated standardized patient-based into nursing curricula.

Knowledge and Attitude of the General Public Toward Palliative Care in Jordan: A Cross-Sectional Study.

Palliative care is directed to relieve the symptoms of serious and life-threatening illnesses. Unfortunately, it's usually provided lately in the disease course in developing countries due to a lack of awareness about its concept, which deprives many patients of its benefits. This study aims to investigate the knowledge and attitude of the Jordanian general public toward palliative care. A cross-sectional study was conducted using an electronic questionnaire via social media platforms. Knowledge about palliative care was measured using the "Palliative Care Knowledge Scale" (PaCKS), whereas the attitude was measured using an edited version of the "Frommelt Attitudes Toward Care of the Dying -B(FATCOD-B)" tool. The inclusion criteria were adults older than 18 years old who live in Jordan. Any subject who was younger than 18 years old, refused to give informed consent, and working or studying in a healthcare-related profession was excluded. 329 respondents filled out the survey (females = 214 (65%), mean age = 32.7 ± (13.63) years). Only 67 respondents (20.4%) heard about palliative care previously. The average knowledge score (out of 13) was 6.8 (±4.2). The average attitude score (out of 5) was 3.0 (±.4). Higher knowledge self-evaluation, older age, and higher income were factors associated with a higher level of knowledge and favorable attitude toward palliative care. Our study showed a moderate knowledge and neutral attitude toward palliative care. Further awareness campaigns should be conducted to raise the awareness of the Jordanian society regarding the objectives of palliative care.

Effects of a Discourse Intervention on End-of-Life Knowledge and Attitudes of Bachelor of Science in Nursing Students.

Several challenges exist to providing effective, formalized end-of-life education for undergraduate nursing students. The purpose of this study was to determine whether the addition of a discourse intervention to the End-of-Life Nursing Education Consortium Undergraduate Nursing Modules effectively improved junior-level prelicensure bachelor of science in nursing students' knowledge and attitudes toward end-of-life care. This quasi-experimental 2-group comparison, pretest/posttest design consisted of a sample of 135 enrolled in a medical-surgical nursing class. Applying Mezirow's transformational learning theory, a 2-hour discourse intervention that included a self-reflective journal, an unfolding case study focused on loss, and a discussion with question-and-answer session was implemented at the completion of the Undergraduate Nursing Modules for the intervention group. Knowledge and attitude toward end-of-life care were measured before and after the intervention with the Palliative Care Quiz for Nurses and the Frommelt Attitude Toward Care of the Dying. The findings indicated increased knowledge and positive attitude changes. This study supports the value of theory-based educational interventions, like a discourse intervention, to enhance effective pedagogy when addressing emotionally laden content such as end-of-life care. This study may have also given a glimpse of how a global pandemic may affect end-of-life knowledge and attitudes.

Long-Term Impact of the End-of-Life Care Nursing Education Consortium on Knowledge, Attitudes, and Practice (KAP) of Indian Nurses Working in Non-Palliative Care Settings: A KAP-GAP Analysis.

Background: The End-of-life Care Nursing Education Consortium (ELNEC) program aims to equip nurses with knowledge and skills in palliative and end-of-life care. While this program improves knowledge and attitudes of Indian nurses regarding palliative care and end-of-life care, its long-term impact on their knowledge, attitude, and clinical practice remains unknown. This study aims to assess ELNEC's long-term impact on knowledge, attitude, and practice of Indian nurses. Methods: A 18-month follow-up survey of practicing nurses at a tertiary care institute who completed ELNEC in September 2021. Data was collected between April-June 2023 via a questionnaire covering demographics, Palliative Care Quiz for Nurses (PCQN), Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B) and a clinical practice questionnaire developed and validated to access impact of ELNEC on clinical practice. Quantitative and qualitative data were assessed using Statistical package for social sciences and thematic analysis respectively. The 18-month follow-up PCQN and FATCOD-B scores were compared with the pre-ELNEC (baseline) and immediate post-ELNEC scores. Results: Out of 108 nurses, 69 responded with a response rate of 63.8%. The mean follow-up PCQN score was 9.03 ± 2.58; significantly higher than the pre-ELNEC (8.45 ± 1.88) but lower than the immediate post-ELNEC scores (10.2 ± 1.88). Attitudes toward end-of-life care declined over time but remained positive in the end-of-life care value and care of the dying. Thematic analysis of responses to open questions revealed that ELNEC motivated nurses to work in palliative care and care for patients with chronic life-limiting illnesses (n = 52, 75.3%), improved their nursing practice (n = 60, 86.9%), and helped enhance their communication skills (n = 51, 73.9%). Participants (n = 55, 79.7%) emphasized on regular palliative care training to reinforce their knowledge and skills. Conclusion: Compared with baseline, ELNEC leads to long-term improvement in practicing nurses' palliative care knowledge, clinical practice, communication skills and motivates them to work in palliative care.

Palliative care knowledge and attitudes toward end-of-life care among intensive care unit nurses in Jordan.

There is a growing need for palliative care globally due to the rapid aging of the population and improvement in cancer survival rates. Adequate knowledge and a positive attitude are vital for palliative care nurses. The study's purpose was to examine nurses' knowledge and attitudes toward palliative care. A cross-sectional design with convenience sampling was used. The study included 182 intensive care unit (ICU) nurses from Jordanian hospitals in all sectors. Self-administered questionnaires were used to assess nurses' knowledge and attitudes toward palliative care. Descriptive statistics, analysis of variance, and the Kruskal-Wallis H test were used to analyze the data. We measured nurses' knowledge using the Palliative Care Quiz for Nursing, and we measured nurses' attitudes using the Frommelt Attitude Toward Care of the Dying scale. The mean total knowledge and attitude scores were 8.88 (standard deviation [SD], 2.52) and 103.14 (SD, 12.31), respectively. The lowest level of knowledge was in psychosocial and spiritual care (mean, 0.51±0.70). The percentage of nurses with unfavorable attitudes was 53.3%. Significant differences in knowledge and attitude levels were observed according to educational level, experience, and hospital type. ICU nurses have insufficient knowledge and inappropriate attitudes toward palliative care. Knowledge of psychological and spiritual aspects of palliative care was particularly lacking as were appropriate attitudes towards communication with dying patients. Improving knowledge and attitudes toward palliative care in nursing schools and hospitals would help overcome this problem.

Exploring the variations in death anxiety among oncology nurses in China: a latent class analysis

BackgroundVarious factors have been found to be associated with high levels of death anxiety experienced by oncology nurses. The aim of this study was to use a person-oriented approach to examine the death anxiety patterns of Chinese oncology nurses and to analyze the differences in anxiety characteristics and their associated influencing factors.MethodsA cross-sectional survey regarding palliative care among registered oncology nurses was conducted in Jiangsu Province, China.Latent class analyses was applied to identify their patterns of death anxiety. The score of PCQN-C (The Chinese version of the Palliative Care Quiz for Nursing) and FATCOD-B-C (The Chinese version of the Frommelt Attitude Toward Care of the Dying scale), the demographic and working characteristics were further analyzed through covariance analysis (ANCOVA) and multivariate (or logistic) regression across the subgroups.ResultsA two-potential-category model was selected based on the fit index. The results showed that 79% of oncology nurses belonged to the high pressure and pain group and 21% belonged to the low death anxiety group. The high pressure and pain group had significantly higher scores in the dimensions of emotion, stress and pain, time awareness, and cognition compared to the low death anxiety group. Factors influencing the high pressure and pain group included shorter working years, non-national or provincial oncology nursing specialists, non-national palliative care specialists, never discussing the topic of death with patients or family members, no palliative care related training, and PCQN and FATCOD scores.ConclusionsOur study suggests that oncology nurses’ death anxiety can be divided into two categories: low death anxiety and high stress pain, and certain factors, such as being female, having a short work experience, and lacking palliative care-related training, increase the likelihood of death anxiety.

Effects of a death education based on narrative pedagogy in a palliative care course among Chinese nursing students.

Death education has been confirmed to be an effective method to enhance nursing students' attitudes and coping abilities toward death. However, integrated Narrative Pedagogy into the death education to explore educational effectiveness is still limited. The study aimed to evaluate the effects of a death education based on Narrative Pedagogy in a palliative care course on the attitude toward death, coping with death, and attitude toward caring for the dying among undergraduate nursing students in China. The study was designed as a pre-post intervention study with a quasi-experimental design. All the participants received 6 class hours of death education which was designed in a palliative care course. The death education includes preparation, presentation, discussion, reflection, and practice of the narrative materials. Death Attitude Profile-Revised (DAP-R), Coping with Death Scale (CDS), and Frommelt Attitude Toward Care of the Dying-Form B (FATCOD-Form B) were used to measure outcomes. Sixty undergraduate nursing students who consented. There were statistically significant increases in the mean score of neutral acceptance and approach acceptance in the DAP-R, CDS, and FATCOD-Form B before and after the intervention. This death education integrated Narrative Pedagogy which indicated to improve attitude toward death, competence to cope with death, and attitude toward the care of dying patients. The findings assist teachers in understanding the importance and urgency of death education, as well as providing a favorable approach to death education. However, the long-term effectiveness still needs to study in further.

Nursing Students' Intention to Work in Hospice Care in the Future: A Cross-sectional Study.

Studies reveal that nursing students rank hospice nursing among their least preferred career choices. The purpose of this study was to explore the association between nursing students' intention to work in hospice care in the future and their attitudes toward caring for dying patients, death anxiety, personal and/or professional experience of caring for dying patients, and type of nursing program studied. In this cross-sectional study, 200 nursing students completed an online survey based on the Frommelt Attitude Toward Care of the Dying Scale and the Turkish Death Anxiety Scale. Only 11% of the respondents were found to express interest in working in hospice care in the future. Studying in the accelerated program for nonnursing Bachelor of Arts graduates predicted a higher intention to work in hospice care in the future, than studying in the generic program (β = 0.27, P < .001). Completion of clinical experience in a medical ward predicted lower intention (β = -0.21, P < .01). These findings suggest that nursing students in the accelerated program for nonnursing Bachelor of Arts graduates should be provided with appropriate experience and support to maintain their interest in hospice nursing. Clinical experience in medical wards does not seem to be a good substitute for clinical experience in hospice care.

Determinants of Attitude Toward End-of-Life Care Among Junior Physicians: Findings from a Nationwide Survey in Japan.

Physicians' attitudes can be critical in quality end-of-life care. However, the determinants of the attitudes and whether the attitudes can be modified remain unclear. To investigate factors correlated with physicians' positive attitudes toward end-of-life care and whether these attitudes are modifiable through acquired factors (e.g., education or mentorship). A nationwide survey was conducted in 300 institutions and selected randomly from 1037 clinical training hospitals in Japan. From each selected institution, two resident physicians of postgraduate year (PGY) 1 or 2 and two clinical fellows from PGY 3-5 were requested to answer the survey. The primary outcome was the Frommelt Attitudes Toward the Care of the Dying (FATCOD) scale score. Factors (e.g., the respondents' age, sex, number of years of clinical experience, training environment, religion, and beliefs around death) were examined for correlation with FATCOD score. In all, 198 physicians and 134 clinical fellows responded to the survey (response rate: 33.0% and 22.3%, respectively). Factors with the strongest correlation with FATCOD scores were mostly unmodifiable factors (e.g., being female and one's beliefs around death). Modifiable factors were also identified-number of patient deaths experienced, level of interest in palliative care, availability of support from senior mentors, and frequency of consultation with nonphysician medical staff. Physicians' attitudes toward end-of-life care correlate more strongly with nonmodifiable factors, but attitudes can be meaningfully improved via mentoring by senior physicians. Future studies are warranted to determine the effective interventions to foster positive attitudes among physicians involved in end-of-life care.

Attitudes towards death and dying among intensive care professionals: A cross-sectional design evaluating culture-related differential item functioning of the frommelt attitudes toward care of the dying instrument

ObjectiveThe objective is to examine whether one of the most used instruments for measuring attitudes towards caring for dying patients, the Frommelt Attitude Toward Care of the Dying (FATCOD-B) instrument, has the same meaning across different societal contexts, as exemplified by Swedish and Saudi Arabian intensive care professionals. MethodsA cross-sectional design used the 30-item FATCOD-B questionnaire. It was distributed to intensive care professionals from Sweden and Saudi Arabia, generating a total sample of 227 participants. Ordinal logistic regression models were used to examine the differential item functioning (DIF) for each item. ResultsUp to 12 of the 30 items were found to have significant DIF values related to: (a) Swedish and Saudi Arabian intensive care professionals, (b) Swedish and Saudi Arabian registered nurses (RNs), (c) RNs’ levels of experience and (d) RNs and other intensive care professionals in Saudi Arabia. ConclusionsThe results indicate that FATCOD should be used cautiously when comparing attitudes towards death and dying across different societal and healthcare contexts.

A palliative care communication simulation for undergraduate nursing and midwifery students: A pilot study.

Undergraduate nursing education prepares student for entry into the profession. Palliative care is an essential component of nursing education; however, a focus on the management of symptom burden fails to prepare the undergraduate in communication skills required for palliative or end-of-life care (EoLC). Simulation to teach acute care is well researched; however, limited studies explore simulation for palliative care or EoLC. Fewer studies combine communication with palliative care simulation. The overarching aim is to explore the influence of a palliative care communication simulation on undergraduate nursing students. Participants were students recruited from two campuses at a major Australian university in 2021. Students attended a compulsory simulation for all nursing or nursing and midwifery students. Pre- and post-simulation questionnaires collected qualitative and quantitative responses from participants. This paper reports that the quantitative data captured included demographic information, and the Frommelt Attitude Toward Care of the Dying (FATCOD-B) tool, to assess the attitudes. The qualitative component of the research will be reported as a separate paper. A statistically significant increase in FATCOD-B scores was observed between pre- and post-simulation questionnaires, as well as a statistically significant difference related to the gender of participants. Age and previous experience with death also impacted FATCOD-B results. The increase in FATCOD-B scores demonstrate that the positive impact of simulation suggests the importance of educational interventions such as the one conducted in this study. Education to improve the attitude toward caring for the dying and communication skills for difficult conversations are relevant and valuable. Further research is indicated.

Improving nursing students attitudes to end of life care using a 360° video vignette

Extended reality (XR) simulation has been shown to be a valuable teaching-learning strategy. A pilot quasi-experimental study pretest-posttest using one group design was utilized using the Frommelt Attitude Toward Care of the Dying (FATCOD) Scale B. A paired t-test demonstrated a significant difference in scores noted at p=0.5. XR simulation that exposes novice student nurses to death and dying may foster more positive attitudes in caring for dying patients.

The Relationship Between the Levels of Thanatophobia and the Attitudes Towards the Care of Dying Patients Among Student Nurses.

This study aims to examine the relationship between the levels of thanatophobia and the attitudes towards the care of dying patients among student nurses. It is descriptive, cross-sectional, and correlational. 140 student nurses studying at the faculty of health sciences of one foundation university participated in it. We collected research data using 'Defining Features of a Student Nurse Form', 'Frommelt Attitude Toward the Care of the Dying Scale', and 'Thanatophobia Scale'. 17.1% of student nurses were deeply affected by death in the last year and 38.6% stated that a patient they cared for died during their internship. The thanatophobia scale scores of student nurses who chose their profession willingly were higher on a statistically meaningful level than those participants who did not choose their profession willingly. We found a statistically significant (p < .05) difference between the FATCOD scale scores of interns and their gender, family type, having been affected by death, and willingness to care for dying patients. We suggest that nursing students should more often provide care to dying patients before graduation.

Assessment of the Competence of Nurses in Taking Care of a Dying Patient in Poland.

During nursing education, few practical hours are devoted to comprehensively preparing students to care for a dying patient. Contact with a dying patient is a key element of the job of every working nurse in the profession. Therefore, it is necessary to properly prepare nurses to care for a dying patient. This study aimed to assess the professional competence of nurses in caring for a dying patient and the factors that affect this preparation. This study involved 223 nurses during master's degree in nursing at the Medical University of Warsaw, receiving either full-time education (group I, N = 121) or hybrid education (group II, N = 102). The study used the FATCOD-BP ((Frommelt Attitudes Toward the Care Of the Dying scale Form B, Polish version)) questionnaire (Cronbach's alpha 0.75), an original questionnaire containing questions about feelings experienced during the SARS-CoV-2 virus pandemic and sociodemographic questions. FATCOD-BP for all groups was below average regarding caring for a dying patient (M = 109, SD = 11.68). Nurses pursuing full-time education were better prepared to care for a dying patient than were nurses pursuing hybrid education. Nurses who exhibited fear of their own deaths had a lower subjective level of preparation for caring for a dying patient. (1) Nurses are not sufficiently prepared to care for a dying patient. (2) The training of nurses should be provided in the form of in-patient education, and the methods of training should be modified by increasing the number of hours of practical and theoretical instruction in palliative care for a dying patient.

Knowledge and Attitude toward End-of-Life Care of Nursing Students after Completing the Multi-Methods Teaching and Learning Palliative Care Nursing Course

Introduction: This study aims to assess the palliative care nursing (PCN) knowledge and attitude of nursing students toward end-of-life care (EoLC) after completing the multi-methods PCN courses. Methods: A quasi-experimental study with a pre-and post-palliative survey was conducted. One hundred and sixty five nursing students from a faculty of nursing in Indonesia were enrolled, and knowledge and attitude were assessed using the palliative care quiz for nurses (PCQN) and the Frommelt Attitude Toward Care of the Dying and Death (FATCOD). Paired t-test and ANOVA were applied in this study. Results: After being involved in the PCN course, the mean score of PCN knowledge of the students increased significantly (p &lt; 0.001). According to sub-domain analysis, the knowledge increased significantly in pain and symptom management (p &lt; 0.001) and not significantly in the domains of theory and principle of the palliative, psychosocial, and spiritual care (p = 0.053; p = 0.080). Moreover, students’ attitude toward EoLC also increased significantly (p &lt; 0.001), and positive attitudes increased from 75.6% to 91.5%. According to the ANOVA test, knowledge in two different groups (witnessed dying people and GPA) is not statistically meaningful (FWDP (1158) = 0.817, p = 0.367; FGPA (2.158) = 1.143, p = 0.322). Similarly, attitudes toward EoLC in two different groups are not statistically meaningful (FWD (1158) = 0.971. p = 0.326, FGPA (1157) = 1.278, p = 0.281). Conclusion: PCN courses with multi-method learning and teaching are effective to increase PCN knowledge, particularly in pain and symptom management knowledge, and also effective in increasing the positive attitudes toward EoLC.