Unpacking Multi-Layered Challenges in Palliative Care Transitions: A Descriptive Qualitative Study of...

This study aimed to explore the challenges faced by Chinese multidisciplinary teams in transitioning patients with life-limiting illnesses to palliative care, utilizing the social-ecological model as a framework.

A descriptive qualitative study was conducted involving 39 multidisciplinary team members, including physicians, nurses, psychologists, social workers, rehabilitation therapists, nutritionists, traditional Chinese medicine therapists, nursing attendants, and volunteers from six health institutions. Data were collected through semi-structured focus group interviews and analyzed using both inductive and deductive thematic analysis.

Four themes were identified: 1) dilemmas in individual end-of-life decision-making rights, with three subthemes: irrational perceptions hindering rational decision-making, the agony of life-and-death decision-making, protective medical practices inducing decision-making rights squeeze; 2) multiple constraints in the family fields, with three subthemes: external stigma of "unfilial" oppression, intrafamilial disparities in palliative care perceptions, distorted emotional connection among family members; 3) Intrinsic barriers in healthcare provision, with three subthemes: institutional deficits in palliative care literacy, professional competence gaps in palliative care delivery, and deficiency in quality control system for palliative care; and 4) constraints shaped by social environment, with four subthemes: insufficient funding support for palliative care, ambiguous palliative care pricing mechanisms, absence of practitioner safeguards in palliative care, and entrenched perceptions of life and death.

Palliative care transition were shaped by multi-layered challenges across micro-macro systems, rooted in cultural norms, healthcare provision, and structural inequities. Challenges such as protective medical care, stigma around "unfilial" behavior, and emotional connection within families offer novel perspectives on promoting palliative care transition. Addressing these challenges necessitates targeted strategies across patients (eg., implementing advance care planning consultations), families (eg., the reconceptualization of filial piety and its recalibration), healthcare institutions (eg., establishing evidence-based standards, guidelines, and screening tools), and social environment (eg., implementing universal death education to dismantle stigma). These strategies could promote culturally sensitive and sustainable palliative care transitions within similar healthcare and sociocultural contexts.