Heterogeneity and associated factors of palliative care core competency among oncology nurses: a latent profile analysis.

BACKGROUND

Global cancer incidence is expected to rise by 60% by 2040, intensifying the burden experienced by patients and their families. Palliative care improves quality of life in advanced disease and depends on oncology nurses' competencies in ethical decision-making, symptom management, and psychological resilience. Despite moderate overall proficiency, psychosocial shortcomings and heterogeneity in competency remain insufficiently characterized. This study utilized latent profile analysis (LPA), guided by shared decision-making and symptom management theories, to identify competency subgroups and associated factors among Chinese oncology nurses, aiming to guide targeted training interventions.

METHODS

A cross-sectional survey was conducted among 241 oncology nurses from five hospitals in Shenzhen, China, between April and September 2025, using cluster sampling. Data were collected using a general information questionnaire, the 32-item Core Competency Questionnaire, and the Nurses' Professional Identity Scale. LPA models (1-4 classes) were fitted using R software (version 4.4.0). Univariate analyses, Analysis of Variance or Kruskal-Wallis H tests, and multivariate logistic regression were performed with SPSS 29.0 to evaluate demographic and occupational factors associated with profile membership.

RESULTS

The mean core competency score was 76.02 ± 23.85 (59.3% of maximum). LPA revealed three distinct profiles: low-competency (27%), moderate -competency (45%), and high-competency (28%). The three-profile solution was selected by considering model fit indices, entropy, class proportions, and substantive interpretability (entropy = 0.931; Lo-Mendell-Rubin and bootstrap likelihood ratio tests P < 0.001). High-competency nurses scored 1.8-fold higher in ethical care, 2.4-fold higher in clinical practice, and 2.0-fold higher in psychological self-adjustment compared with the low-competency group (all P < 0.001). Systematic palliative care training was associated with higher odds of membership in the high-competency profile rather than the moderate-competency profile (OR = 3.210, 95% CI [1.298-7.940], P = 0.012). Higher average monthly night-shift frequency was associated with lower odds of membership in the low-competency profile rather than the moderate-competency profile (OR = 0.887, 95% CI [0.788-0.998], P = 0.046). Profiles diverged significantly in professional identity (F = 24.11, P < 0.001, η 2 = 0.17).

CONCLUSION

Oncology nurses exhibit heterogeneous palliative care competencies characterized by strong ethical, moderate clinical, and weak psychological capacities. Systematic training was associated with high-competency profile membership, and targeted programs focusing on psychological self-adjustment may be explored in future longitudinal or interventional studies.