Objectives The objective of this study was to assess the palliative care needs of patients with neurological conditions through the application of the Supportive and Palliative Care Indicators Tool (SPICT) and explore the factors associated with the identification of palliative care needs. Methods This cross-sectional descriptive study employed convenience sampling to recruit 337 patients with neurological disorders from a tertiary hospital in China. Data were collected using the Chinese version of the SPICT. Descriptive statistics and χ 2 tests (p < 0.05) were used for analysis, and the prevalence of palliative care needs was calculated. Results While the SPICT identified 45.1% of patients with neurological disorders as needing palliative care, physicians identified only 0.3%. Age, body temperature, length of hospital stay, admission route, Braden Scale, Padua Prediction Scale, Barthel Index, Nutrition Risk Screening 2002 and Glasgow Coma Scale were influential factors in identifying patients with palliative care needs. Conclusion These results highlight that a substantial proportion of patients with neurological disorders had unmet palliative care needs, and these were largely unrecognised by physicians. The SPICT proved useful for early identification and may support more timely and appropriate palliative care interventions in this population.