“It sounds unfamiliar, yet appealing”: a qualitative study on perceptions of a good death and hospice care needs among older adults in remote rural China

Hospice care remains largely inaccessible in remote rural regions of China. Discussions about death are often considered cultural taboos, and older adults in these areas face significant disparities in end-of-life care due to low socioeconomic status, limited transportation, and insufficient healthcare infrastructure. Few studies have examined how this population conceptualizes a good death or their willingness to receive hospice care. This study explores rural Chinese older adults’ expectations and needs regarding a good death, as well as their perceptions of hospice care. We conducted semi-structured, open-ended interviews with 21 older adults and performed an inductive thematic analysis on the collected data. Six key themes emerged: family presence at the end of life under structural constraints, dying at home as a culturally grounded and practically shaped choice, relief from uncontrolled physical and financial suffering, emerging interest and interpretations of hospice care, structural and policy barriers to dignified end-of-life care, and pursuit of inner peace through relational and emotional fulfillment. These findings reveal the complex, interconnected, and multidimensional nature of older adults’ perceptions of a good death and their understanding of hospice care in remote rural areas. The findings highlight the urgent need to strengthen hospice services in rural China, ensuring they are accessible, meaningful, and responsive to local economic, caregiving, and geographic conditions. Future research and practice should focus on implementing a coordinated three-tiered county-township-village hospice care service model to expand and sustain hospice care effectively.