Perceived barriers to implementing palliative care communication among healthcare professionals: a qualitative study based on the theoretical domains framework

Effective palliative care communication supports care aligned with patients’ values, yet its implementation is constrained by individual, organisational and sociocultural barriers. The Theoretical Domains Framework (TDF) integrates behavioural determinants and offers a structure for examining these barriers. This study explored perceived barriers to palliative care communication among physicians and nurses in a Chinese tertiary hospital to inform intervention development. A qualitative descriptive study was conducted from December 2025 to February 2026. Twenty physicians and nurses working in palliative care-related departments were recruited from a tertiary Grade A hospital in Shenzhen, China, using purposive sampling. Semi-structured, face-to-face interviews were audio-recorded with consent and transcribed verbatim within 24 h; data were managed in NVivo 14. Barriers were identified through framework analysis combined with thematic development. The study included 12 nurses and eight physicians. Interview data were mapped onto six TDF-derived analytic groupings (combining ‘knowledge’ and ‘skills’), which spanned seven of the 14 original TDF domains. Six overarching barrier themes, comprising 13 subthemes, were identified: insufficient understanding and lack of communication skills, decision-making difficulties, lack of resources for palliative care, sociocultural resistance, emotional strain, and lack of communication support mechanisms. Data corresponding to the remaining TDF domains were retained in the overall analysis but were not presented as standalone themes because they were sparse or fragmented. Physicians and nurses perceived barriers related to knowledge and skills, decision processes, resources, social influences, emotional strain and communication support. The TDF helped organise these accounts and identify candidate targets for locally adapted interventions. The feasibility and effects of these interventions require further evaluation.