Understanding rural Chinese residents' perceptions of palliative care: a grounded theory study of beliefs about a good death.

BACKGROUND: Palliative care development in China remains marked by urban-rural inequality, with service expansion concentrated mainly in urban and better-resourced settings. Older residents in rural areas may therefore face limited access to professional palliative care, despite substantial care needs. This study aimed to explore rural Chinese residents' perceptions of, needs for, and underlying decision-making logic regarding palliative care, to inform the development of culturally responsive rural palliative care services. METHODS: This qualitative study used purposive sampling to recruit rural residents from nine provinces and one municipality in the Chinese mainland. After quality screening, 39 interviews involving 43 participants were included and analysed using a grounded theory approach. RESULTS: The analysis generated the "Rural Belief about Good Death" framework, comprising four interrelated dimensions: familism as the core principle, attachment to ancestral homeland as the affective orientation, traditional filial piety as the ethical norm, and family economic security as the threshold condition. Participants' attitudes towards palliative care were not shaped by medical considerations alone, but were embedded in family-centred, place-based, morally charged, and economically constrained understandings of a good death. CONCLUSIONS: Rural palliative care in China should be developed through locally responsive models that preserve family involvement, support home-oriented care, translate palliative care into culturally meaningful terms, and reduce financial barriers. The framework offers empirical and theoretical insights for developing palliative care in rural and resource-limited settings.