Factors Associated With End‐of‐Life Care Practice in Nonspecialist Palliative Care Settings: A Capability–Opportunity–Motivation Perspective

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Abstract
Background: End‐of‐life care is often delivered in nonspecialist palliative care settings. However, challenges in end‐of‐life care practice persist in such settings, and associated factors remain underexplored. Aims: To examine how capability‐, opportunity‐, and motivation‐related factors are associated with end‐of‐life care practice among nurses and physicians working in nonspecialist palliative care settings. Design: A cross‐sectional survey. Methods: Nurses and physicians employed at a tertiary hospital in China and providing direct patient care were recruited. Measures assessed capability‐related factors (end‐of‐life care competence and self‐rated physical health), opportunity‐related factors (social and organizational environments), and motivation‐related factors (outcome expectations and compassion satisfaction), with end‐of‐life care practice as the outcome. Data were analyzed using structural equation modeling. Results: A total of 342 participants were included in the analysis, of whom 82.7% were nurses. End‐of‐life care competence showed both direct ( β = 0.413, p < 0.001) and indirect associations with end‐of‐life care practice through outcome expectations ( β = 0.059, 95% CI [0.010, 0.138]). The social environment was indirectly associated with practice through outcome expectations ( β = 0.082, 95% CI [0.024, 0.189]). Poor or fair self‐rated physical health showed a small negative association with practice through outcome expectations ( β = −0.022, 95% CI [–0.056, −0.001]). Organizational environment and compassion satisfaction were not significantly associated with practice in the structural model. Overall, the model explained 32% of the variance in end‐of‐life care practice. Conclusion: End‐of‐life care competence was associated with end‐of‐life care practice, while outcome expectations were involved in the indirect associations of both competence and the social environment with practice. These findings highlight the potential relevance of competence and outcome expectations to end‐of‐life care practice in nonspecialist palliative care settings. Implications for Nursing Management: Nursing managers may consider prioritizing competency‐based education and continuing professional development, while considering the social environment and healthcare professionals’ outcome expectations related to end‐of‐life care practice.

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