Exploring quality of death in Chinese hospice and palliative care units: a qualitative perspective from practitioners in healthcare settings.

BACKGROUND: Quality of death (QoD) in palliative care is a critical yet understudied area of healthcare in China, shaped by complex cultural, familial, and clinical factors. As an emerging medical specialty, palliative care in China increasingly emphasises holistic and person-centred approaches. The understanding of what constitutes a good death in clinical settings however, remains largely Western-centric and is often implicitly defined within unique Chinese sociocultural contexts. METHODS: In-depth, semi-structured interviews were collected from 27 multidisciplinary end-of-life care practitioners across China, including doctors, nurses and social workers. Inductive thematic analysis was conducted to explore the key components of good QoD and the factors influencing it within Chinese hospice and palliative care settings. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure rigour and transparency. RESULTS: Three themes emerged: (1) providing care with dignity through relationships, balancing respect for patients with cultural expectations and medical realities; (2) enhancing communication within family dynamics, involving indirect communication styles, managing family conflicts, and balancing transparency with cultural norms; and (3) negotiating intergenerational dilemmas, where generational differences in attitudes toward death and dying create tensions in care decisions. These findings reveal the challenges that practitioners may face in respecting patient autonomy while addressing family-centred values and medicalised norms. CONCLUSION: The study highlights the importance of improving communication about death and dying, promoting public education on end-of-life care, and tailoring palliative services to integrate Western clinical approaches with traditional Chinese family-centric values to enhance QoD.