Palliative care social work in medical institutions in mainland China: a qualitative study

Palliative care in mainland China is expanding, but palliative social work remains unevenly defined and supported within medical institutions. How social workers negotiate patient, family, professional, organizational, and policy contexts remains insufficiently understood.

To explore the experiences and institutional positioning of palliative social work in medical institutions in mainland China.

A descriptive qualitative study was conducted in 11 medical institutions in Sichuan, Hebei, Guangdong, and Shanghai. Eligible institutions had provided palliative care for at least one year and employed full-time medical social workers. Semi-structured interviews were conducted with 39 participants, including 21 social workers, 5 physicians, 8 nurses, and 5 institutional managers. Data were analyzed in NVivo 12 using Braun and Clarke's reflexive thematic analysis with a primarily inductive orientation. Findings were organized across micro-, meso-, and macro-levels.

At the micro level, social workers supported person-centered end-of-life care by responding to multidimensional needs, mediating patient-family preferences, facilitating communication, and providing emotional, relational, and bereavement support. At the meso level, they acted as boundary-spanning coordinators across professional, institutional, hospital-community, and resource boundaries. At the macro level, their practice was constrained by uneven community resources, limited public understanding of palliative care, and gaps in policy, funding, staffing, training, supervision, career development, and professional standards. Although palliative social work was valued across stakeholder groups, its role remained inconsistently defined and insufficiently institutionalized. Social workers emphasized professional identity and role boundaries, managers highlighted staffing and financing, while clinicians focused more on coordination and public understanding.

In the participating institutions, palliative social work contributed to relational care and cross-boundary coordination but lacked stable institutional support. Clearer role definitions, proactive referral pathways, multidisciplinary participation, adequate staffing and funding, professional training and supervision, and stronger hospital-community-home linkages are needed. Formal recognition and sustainable payment mechanisms warrant policy consideration, but their feasibility requires further research. These findings should not be generalized to all medical institutions in mainland China.