The comparison of spatial patterns and factors associated with healthcare provider knowledge in palliative care in various regions of China

Abstract

As an integral part of the overall life cycle, it is crucial to ensure equity and accessibility to palliative care services at the end of life. The knowledge of healthcare providers has a significant beneficial impact on the quality of palliative care services. This study aimed to compare the nationwide geographic distribution of healthcare providers’ knowledge of palliative care at the provincial level in China and identify the possible factors associated with its geographic disparities. A descriptive cross-sectional study was conducted in all provinces (n = 29) that implemented palliative care pilot programs in China. Data were collected online using a structured questionnaire. The possible factors associated with healthcare providers’ knowledge including economy, demographics, and health, were explored by using exploratory regression and ordinary least squares. In addition, spatial autocorrelation was also examined with Moran’s I, LISA, and Geographically Weighted Regression. A total of 18,272 participants from 903 health institutions in 87 palliative care pilot cities were included across 29 out of 31 provinces in China. The average knowledge score (mean ± standard deviation [SD]) was 8.61 ± 2.85. A positive spatial correlation was observed in healthcare providers’ palliative care knowledge level in China. The high level of knowledge was significantly associated with fewer hospitals per 10,000 population (β = −0.384, 95% CI: −0.601 to −0.168, p = 0.001), more primary healthcare institutions per 10,000 population (β = 0.220, 95% CI: 0.032–0.407, p = 0.024), and more community health center visits (β = 0.259, 95% CI: 0.054–0.465, p = 0.016), with higher coefficients being observed in the northwest and northeast regions. This study suggested that the knowledge level of palliative care among healthcare providers nationwide was relatively low, indicating the existence of a disparity between the supply and demand of palliative care services. There may be regional disparities in palliative care services based on the substantial geographical variation in healthcare provider knowledge, emphasizing the necessity of tailored interventions targeting areas with the greatest need.