Abstract
Objective: This study aimed to assess the healthcare workers' knowledge and belief in palliative care, as well as their self-efficacy, and identified factors that influence these outcomes.
Methods: A cross-sectional survey was conducted among physicians, nurses, and medical students at two tertiary hospitals in Makkah, Saudi Arabia. A 10-item self-efficacy scale and a 24-item knowledge and beliefs questionnaire were used that were culturally modified and validated. Descriptive statistics, reliability tests, principal component analysis, correlation analysis, and multivariate regression were used to assess knowledge levels, confidence patterns, and predictors.
Results: On a sample size of 199 people, only a quarter of them (27.6) displayed the best knowledge. Correctness rates were quite unpredictable, showing significant misunderstandings regarding the timeliness of palliative care, opioid safety, and symptom management. Self-efficacy was average, and the confidence in technical tasks was higher; confidence in communication and ethical decision-making was lower. Self-efficacy and knowledge only demonstrated a weak relationship. Multivariate analyses revealed two independent predictors of optimal knowledge which were caring for more than ten terminally ill cancer patients and frequent interactions with palliative teams, and exposure to terminally ill patients alone predicts self-efficacy.
Conclusion: Major knowledge gaps and a lack of confidence in communication and ethical aspects of end-of-life care persisted among Saudi healthcare workers, which can be attributed in part to cultural and spiritual perspectives on end-of-life care. To improve preparedness and quality of care, curricula should be improved, formal clinical experience increased, and culturally relevant palliative care training and mentorship incorporated.

Key words: Palliative care, knowledge and beliefs, self-efficacy, healthcare professionals, end-of-life care, Saudi Arabia.