Background: Food and mealtimes are fundamental aspects of human wellbeing, both considering physiologicalaspects of human life and social interactions. Since registered nurses are key caregivers in palliative care, the aim of this study was to explore registered nurses' perceptions of food and mealtimes in palliative care.

Methods: An exploratory and descriptive cross-sectional, study-specific survey, designed following a systematic review of the literature, was administered online. The study-specific questionnaire consisted of statements about mealtimes in palliative care, and registered nurses were asked to rate the extent to which they agreed with each statement. Using linear regression analysis associations between socio-demographic variables and registered nurses' perceptions were explored. Additionally, one open-ended question was analysed using deductive content analysis.

Results: Registered nurses (n=100) had a mean score of 3.3 on the 4-point scale, indicating agreement with the statements about food and mealtimes. Registered nurses agreed to the largest extent with statements concerning registered nurses' responsibilities (mean score 3.7), and to the least extent regarding food as improving health and wellbeing (mean score 2.8). Higher age among registered nurses was statistically significant and associated with a lower degree for food and mealtimes are perceived as distressing (P=0.004) for patients and family. The open-ended question about "what advice would you give a new colleague about food and mealtimes in palliative care?" pertained to the physical (56%), the social (14%), the psychological (9%), and the existential dimensions (4%), palliative care approach was covered by 17% of the text.

Conclusions: Registered nurses reported that food and mealtimes in palliative care cause distress for patients and families. They strongly agreed on the importance of addressing issues around food and mealtimes at the end of life, helping patients and families to understand that it is common to stop eating as death approaches. Advice to new colleagues focused mainly on physical care, with fewer registered nurses offering guidance on psychological, social, or existential dimensions. This study highlights the need for support in adopting a holistic approach to mealtimes in palliative care.