Background: Although palliative care is recognised as an essential component of comprehensive oncology practice, workforce readiness for its early integration remains uncertain, particularly in low- and middle-income countries. Beyond knowledge assessment alone, identifying independent determinants of preparedness is critical for informing competency-based educational reforms.
Methods: A cross-sectional study was conducted among doctors, MBBS interns and nursing staff at a tertiary care teaching institution in India, selected because it provides multidisciplinary care to patients with advanced illnesses. Data were collected using a structured questionnaire adapted from previously validated palliative care knowledge–attitude–practice instruments. Of 200 distributed questionnaires, 193 complete responses were included in the final analysis. The survey assessed knowledge across four core domains, communication confidence, beliefs regarding early palliative care integration, opioid regulatory perceptions, clinical exposure and prior training. A composite Workforce Preparedness Index was constructed by standardising and averaging knowledge and attitudinal components. Statistical analyses were performed using R version 4.5.3 (R Foundation for Statistical Computing, Vienna, Austria). Multiple linear regression was used to identify independent predictors of preparedness.
Results: Of 200 responses, 193 (96.5%) were included in the final analysis. Among the participants, 117 (60.6%) were MBBS interns, 46 (23.8%) were nursing staff and 30 (15.5%) were doctors; 70 (36.3%) had received prior formal palliative care training. Poor knowledge (score 0–1/4) was observed in 103 (53.4%) participants, whereas only 7 (3.6%) achieved the maximum score. In multivariable analysis (R² = 0.137, p < 0.001), increasing years of clinical experience was independently associated with lower workforce preparedness (B = −0.13, p = 0.003). Compared with doctors, nursing staff demonstrated significantly higher preparedness scores (B = 1.66, p = 0.048). Prior formal training, frequency of exposure to patients requiring palliative care, gender and MBBS intern status were not independently associated with preparedness. Lack of structured training was identified as the most frequently reported barrier by 138 (71.5%) participants.
Conclusion: Workforce preparedness for early palliative care integration appears influenced more by professional role and generational factors than by prior formal training alone. These findings suggest that experiential, competency-based educational models may be required to strengthen integration within oncology services.
