Training Needs of Palliative Care Advanced Practice Nurses in China: A National Multicenter Survey

Every year, millions of people around the world face illnesses that cannot be cured. For these individuals, the goal of medicine shifts from fighting the disease to managing pain, easing suffering, and supporting the emotional and spiritual needs of the patient and their family. This specialized approach is called palliative care. It is a vital part of health systems everywhere, yet there is a massive shortage of professionals trained specifically for this delicate work. In many places, the people who provide this care are nurses. However, the role of a nurse in palliative care is complex. It requires more than just medical skill; it demands the ability to guide families through difficult conversations, coordinate with doctors and social workers, and make tough ethical decisions when a patient is nearing the end of life. To do this well, nurses need advanced training, but in China, a system for teaching these specific skills has not yet been fully built.

Researchers in China recently set out to understand exactly what these nurses need to learn. They focused on a group known as Palliative Care Advanced Practice Nurses. These are experienced nurses who have taken on a higher level of responsibility, acting as experts who can manage complex symptoms and lead care teams. The team, led by Sansan Jia and colleagues from the Affiliated Cancer Hospital of Zhengzhou University, wanted to know what these professionals felt they were missing. They asked a simple but crucial question: if you could design the perfect training program for a nurse who specializes in end-of-life care, what would it include, how should it be taught, and what stops nurses from attending such programs today? To find the answers, they conducted a massive survey across the entire country, reaching out to nurses in hospitals, clinics, and care centers from December 2025 to January 2026.

The researchers gathered responses from 1,166 nurses, a group that represented a wide cross-section of the profession. Most of the respondents were women, and the vast majority had been working in nursing for more than eleven years. Many held senior titles and worked in oncology, or cancer care, which is where palliative care is most common in China. When the researchers asked these experienced professionals what they needed to learn, the answers were clear and consistent. The nurses did not feel they lacked basic knowledge; instead, they identified specific, high-level skills they wanted to master. The most urgent need was for better communication skills. The nurses wanted to learn how to talk to patients and families about death, how to handle difficult emotional situations, and how to build trusting relationships. The second most important area was learning how to work effectively with other types of professionals, such as doctors, psychologists, and social workers, to create a seamless support system for the patient.

The survey also revealed how these nurses wanted to learn. They did not want long, boring lectures or training that took them away from their jobs for weeks at a time. Instead, the overwhelming favorite was a "blended" approach. This means combining online learning, where they could study theory on their own time, with short, intensive periods of offline practice where they could meet in person to work on real skills. When it came to the actual teaching methods, the nurses were very specific. They wanted to learn by looking at real cases. They preferred to sit down with experts and analyze actual stories of patients they had treated, discussing what went well and what could be improved. They also wanted to practice in simulated scenarios, acting out difficult conversations or complex medical situations in a safe environment before trying them with real patients.

Despite the clear desire to learn, the nurses faced significant hurdles. The biggest barrier was simply a lack of time. Nearly seventy percent of the respondents said they were too busy with their current workload to attend training. A similar number said there were not enough staff members to cover their shifts while they were away learning. This is a structural problem: there are not enough trained nurses to go around, so the ones who are already there cannot leave their posts to get better trained. Family responsibilities also played a role, as many of the nurses are women who balance caregiving at home with their demanding jobs. To overcome these obstacles, the nurses expressed a strong need for support from their employers. They wanted access to online learning platforms that they could use from home, and they asked for more clinical practice bases where they could train without disrupting their daily work. They also hoped that their hospitals would pay for the training, as most were not willing to pay for it themselves.

The study concluded that the need for this specialized training is substantial and immediate. The nurses are ready to learn, but the system needs to catch up. The researchers found that the most effective way forward is to build a training system that respects the nurses' time and their need for practical, real-world application. By focusing on communication, teamwork, and hands-on problem solving, and by delivering this education through flexible online and offline methods, China can begin to build a workforce capable of providing high-quality end-of-life care. The path forward is not just about teaching medical facts; it is about creating a system that allows experienced nurses to grow into the leaders their patients and families need during the most difficult moments of life.