Facilitators and barriers to palliative care delivery in rural China: a qualitative study of the perceptions and experiences of rural healthcare professionals.

Background: Palliative care improves the quality of life and quality of death, yet in China, existing resources remain largely concentrated in urban areas. Limited access to palliative care exacerbates the sufferings of patients with life-threatening diseases such as cancer in rural regions.

Objectives: This study aimed to explore the facilitators and barriers to palliative care delivery in rural China, based on the perceptions and experiences of rural healthcare professionals.

Methods: Between July and August 2024, semi-structured interviews were conducted with 25 participants from rural areas, including 18 village doctors and 7 staff from township health centers (5 doctors and 2 nurses). A thematic analysis approach was used to identify key themes and subthemes.

Results: Three themes were identified, including (1) the necessity of rural palliative care: highlighting the growing population of left-behind older individuals, and poor quality of death in rural areas; (2) facilitators of rural palliative care: including door-to-door service provided by village doctors, close doctor-patient relationships, support from families and neighbors, and care in familiar environment; and (3) barriers of rural palliative care: such as heavy workloads for village doctors, limited professional authority and high perceived legal risk, unbalanced healthcare resources allocation, poor economic conditions, lack of service standards, death-related taboo and stigma, performative filial piety, and limited understanding of palliative care.

Conclusion: Palliative care in rural China remains underdeveloped. There is an urgent need to establish home-based palliative care services in low-resource regions. Implementing hospital-community-home care model can support more equitable allocation of healthcare resources. Expanding insurance reimbursement and promoting culturally adapted death education may further facilitate the delivery and acceptance of rural palliative care.