Assessing nursing students’ palliative care training needs and profiles: a cross-sectional study using K-means clustering

Yang et al. BMC Nursing (2025) 24:1235 https://doi.org/10.1186/s12912-025-03797-0 BMC Nursing Open Access RESEARCH Assessing nursing students’ palliative care training needs and profiles: a cross-sectional study using K-means clustering Liu Yang1, Lanxin Zhang2, Bingjie Long2, Tong Zhu2, Mei Chen1, Simon Ching Lam3* and Renli Deng1* Abstract Background Palliative care is crucial in nursing, yet nursing students often lack adequate training, compromising their ability to provide holistic end-of-life care. Despite growing awareness, research on specific training needs remains limited. Aim This study aimed to assess and classify the training needs of nursing students in palliative care education by using K-means clustering. Design A cross-sectional study. Methods Data were collected in March 2023 from nursing students at a medical university in southwestern China through an online questionnaire. The questionnaire included demographics and the Nurses Receiving In-service Palliative Care Education Needs Scale. Subsequently, K-means clustering was used to analyze the collected data, aiming to identify distinct profiles of nursing students with similar palliative care training needs. Results A total of 695 nursing students participated in the study, with a mean age of 22.40 years and 87.6% being female. Most of the students lacked experience in terminal care (80.4%) and nontextbook palliative care knowledge (74.4%). Nursing students prioritized training needs in ethical issues and teamwork (mean score: 3.71), communication and consultation (mean score: 3.69), and managing symptoms and pain relief (mean score: 3.69), while cultural and spiritual considerations ranked lowest (3.41). K-means clustering identified two distinct profiles: high-level needs (n = 393) and moderate-level needs (n = 302). High-need students reported significantly lower exposure to nontextbook palliative care knowledge compared to moderate-need students (p < 0.001). Conclusion Nursing students exhibit high-level needs of palliative care training, particularly in ethical issues and teamwork, communication and counseling, and handling of symptoms and pain relief. K-means clustering identified two profiles: high-level needs and moderate-level needs groups, differentiated by nontextbook learning exposure. Nursing educators should urgently consider redesigning palliative care training curricula, addressing resource accessibility gaps, and tailoring programs to cluster-specific needs to improve palliative care preparedness. *Correspondence: Simon Ching Lam Renli Deng Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Yang et al. BMC Nursing (2025) 24:1235 Page 2 of 11 Keywords Education, K-means clustering, Nursing students, Palliative care, Training needs Introduction Palliative care is essential to quality nursing practice, focusing on optimizing quality of life for patients with serious illnesses through holistic support for physical, psychological, social, and spiritual needs [1–3]. By emphasizing early needs identification and patient-centered interventions, palliative care addresses complex challenges such as pain, dyspnea, and fatigue, as well as psychological distress, social challenges (especially those related to caregiving arrangements and financial toxicity), and spiritual concerns [2]. Nursing students, as future clinical practitioners, are key palliative care providers whose competencies directly shape patient care quality and experiences [4]. Palliative care requires nursing personnel to master core competencies, including communication, pain management, and emotional support, which nursing students must acquire through specialized training [5, 6]. However, current nursing curricula often lack targeted training, resulting in significant knowledge gaps that compromise care quality and patient satisfaction [7]. Consequently, strengthening palliative care education to enhance students’ clinical preparedness represents an urgent priority in nursing education. Despite increasing global recognition of palliative care’s importance in nursing education [8, 9], research on the specific training needs of nursing students in this field remains limited, particularly in China. While existing studies have assessed students’ overall knowledge and attitudes toward palliative care globally [10–12], few have explored their training needs in palliative care [13, 14] or death education [15]. However, none have systematically identified homogenous subgroups of students with shared training needs (e.g., groups characterized by similar knowledge gaps, clinical exposure levels, or learning preferences) to enable targeted educational interventions. For instance, students lacking practical experience in end-of-life care may require simulation-based training, whereas those with moderate theoretical knowledge might benefit from advanced communication skills workshops. This gap highlights the need for a more nuanced understanding of training needs to tailor educational strategies effectively. To address this gap, our study uses K-means clustering to identify distinct subgroups of Chinese nursing students with homogeneous palliative care training needs, guiding the development of tailored educational strategies for each subgroup. Background Palliative care is a person-centered, interdisciplinary approach that enhances quality of life for patients with life-limiting conditions and their families by addressing physical, psychological, social, and spiritual needs across all ages and disease stages [2]. Registered nurses must demonstrate comprehensive competencies in palliative care, including clinical expertise in managing symptoms (e.g., pain, dyspnea, nausea, fatigue, anorexia) and holistic capabilities to address patients’ and families’ multidimensional needs across physical, psychological, social, and spiritual domains. These competencies extend to advanced practice skills, such as formulating individualized care plans, coordinating multidisciplinary teams, and providing patient/family education throughout the illness trajectory [16, (...truncated)