Factors influencing healthcare professionals’ rating on quality of death and dying: a nationwide cross-sectional study in China

Understanding healthcare professionals' perspectives on the quality of death and dying is essential for improving palliative care in China, especially as hospice and palliative services expand. This study examined how Chinese healthcare professionals' assessments of death and dying quality vary by institutional setting, sociodemographic factors, professional background, and training experience. A cross-sectional design was conducted. Between November 2023 and January 2024, 2,465 healthcare professionals engaged in palliative and hospice care (including doctors, nurses, and social workers) participated in the survey. Multivariate linear regression models and propensity score matching were used to identify factors associated with Quality of Death and Dying Index ratings. Higher ratings on the Index were observed among respondents working in institutions with multidisciplinary end-of-life care teams, those who were female, born in the 1970s, held a bachelor's degree, had longer years of service, cared for patients with a survival period of three to six months, and participated in palliative care training programs. These findings suggest that institutional collaboration, professional experience, and targeted training are closely linked to more favorable perceptions of death and dying quality among healthcare workers. Enhancing multidisciplinary coordination and ensuring equitable access to training opportunities may help improve end-of-life care quality within healthcare institutions. The results provide evidence-based insights into the determinants of death and dying quality in China, offering practical guidance for strengthening palliative and hospice care development in rapidly aging societies where end-of-life service systems are still evolving.