Perception of advance health-care directives among nursing students in oncology and palliative care settings: An Italian pre–post study

Introduction: Advance health-care directives (AHDs) empower individuals to express treatment preferences in anticipation of future incapacity and play a crucial role in ensuring patient-centered end-of-life care. However, nursing students often report limited training and discomfort when addressing these issues. Objective: This study aims to assess the impact of an oncology palliative care module on nursing students’ knowledge and perceptions of AHDs. Methods: In a pre–post observational design, 39 3rd-year nursing students completed questionnaires immediately before (pre-test) and after (post-test) a 75-h oncology palliative care module that included lectures, case discussions, and active learning methods. Sociodemographic and attitudinal data were analyzed using descriptive statistics. Results: After the module, students showed an increased preference for refusing non-beneficial treatments (from 63.6% to 71.4%) and reported heightened awareness of the need for proactive communication regarding therapies and pain management. While willingness to donate organs remained high (94.9% vs. 92.3%), students exhibited increased caution regarding the involvement of minors in end-of-life discussions. Openness to spiritual support also rose, alongside slight increases in preferences for cremation and body donation. Although these changes did not reach statistical significance, the consistency index indicated generally stable ethical orientations, with emerging trends toward deeper reflection and heightened awareness. Conclusion: Although no statistically significant differences were observed, the educational intervention on AHDs appeared to influence certain perceptions and attitudes among nursing students toward end-of-life decisions. Integrating structured AHD training into nursing curricula may enhance students’ awareness and ability to support patient self-determination in clinical practice.