Background <p>The high medical costs of continuous treatment for end-stage renal disease impose significant financial strain on patients and their families, highlighting the need for palliative care. However, the development of renal PC in mainland China remains hindered by substantial challenges.</p> Objective <p>To explore the psychological and behavioral mechanisms that drive medical staff’s engagement in kidney palliative care in mainland China, and to provide empirical evidence to inform future renal palliative care interventions.</p> Methods <p>Based on the KAB model and self-efficacy, 719 valid questionnaires were collected from medical staff (doctors and nurses) specializing in renal care in mainland China. Data were analyzed using SPSS 26.0 for descriptive statistics, Amos 26.0 for model validation, and Process 3.3.1 for mediated effects analysis.</p> Results <p>Medical staff’s knowledge was significantly positively associated with attitudes toward palliative care, while self-efficacy was positively associated with both attitudes and behaviors to palliative care. Hypotheses H2, H3, H4, and H5 were supported. Additionally, attitudes mediated the relationship between self-efficacy and palliative care practices.</p> Conclusion <p>Palliative care knowledge, attitude, and self-efficacy of renal medical staff are associated with practice in mainland China. Therefore, when training medical staff, medical institutions should not only focus on the improvement of skills and knowledge, but also emphasize the shaping of emotions and attitudes, in order to achieve better practice results and promote the development of kidney palliative care in China.</p> Clinical trial number <p>Not applicable.</p>