The Perceptions of Palliative Care Instrument (PPCI) is a tool used to access perceptions towards palliative care in patients with advanced cancer. However, its psychometric properties have not been widely tested using modern psychometric methods. This study aimed to examine the psychometric properties of the PPCI in patients with advanced cancer using Rasch analysis. Four hundred and forty four Participants were recruited from the Department of Medical Oncology at a tertiary care hospital in Xinxiang City, Henan Province, China, between October 2020 and February 2021. Participants completed the PPCI. Rasch analysis procedures were conducted, including assessment of unidimensionality, model-date fit, rating scale function, differential item functioning, item-person map, and person and item reliability. The unidimensionality of the PPCI was confirmed, although two items (18 and 21) did not fit the Rasch model. The degree of fit of each item to its respective dimension was excellent, with Infit MNSQ and Outfit MNSQ values ranging from 0.73 to 1.33. The PPCI demonstrated high reliability, with an item reliability of 0.99 and a person reliability of 0.77. The PPCI is a valid and reliable instrument for assessing perceptions of palliative care in advanced cancer patients. However, to further improve the quality and applicability of the PPCI, the deletion of items 18 and 21 is recommended, as they did not fit the Rasch model.