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ORIGINAL RESEARCH ARTICLE

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

Diego Lopane1,2† ,  Sara Morales Palomares3† ,  Alessandra Dacomi1 ,  Daniela Cattani1 ,  Simone Cosmai2 ,  Chiara Provasoli1 ,  Sarah Scollo2 ,  Mauro Parozzi4 ,  Giovanni Cangelosi5* ,  Stefano Mancin1 ,  Emanuela Morenghi1,2‡ ,  Beatrice Mazzoleni2‡
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1 Scientific Institute for Research, Hospitalization and Healthcare, Humanitas Research Hospital, Milan, Milano, Italy
2 Department of Biomedical Sciences, Faculty of Nursing, Humanitas University, Milan, Milano, Italy
3 Department of Pharmacy, Health and Nutritional Sciences, Faculty of Health Sciences, University of Calabria, Rende, Cosenza, Italy
4 Department of Medicine and Surgery, Faculty of Medicine and Surgery, University of Parma, Parma, Parma, Italy
5 Department of Experimental Medicine and Public Health, School of Pharmacy, University of Camerino, Macerata, Macerata, Italy
†These authors contributed equally to this work.
EJMO, 025250263 https://doi.org/10.36922/EJMO025250263
Received: 18 June 2025 | Revised: 21 July 2025 | Accepted: 23 July 2025 | Published online: 14 August 2025
(This article belongs to the Special Issue Nursing Care in Cancer)
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

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.

Keywords
Advance health-care directives
Nursing education
Patient self-determination
Clinical ethics
End-of-life care
Funding
None.
Conflict of interest
Giovanni Cangelosi and Stefano Mancin are Guest Editors of this special issue. The authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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