End-of-life care in rural China: the crucial role and challenges of village doctors.

objectiveQuality hospice and palliative care are particularly challenging in rural China. This qualitative study aimed to explore the critical role of village doctors in the end-of-life care of rural China amidst challenges posed by an aging population.

methodsForty-six semistructured interviews were conducted in 38 villages across Henan and Shandong Provinces in China. Data were analyzed via thematic analysis.

resultsVillage doctors with at least five years of medical practice were recruited from the student interviewers' hometowns. Among the 46 village doctors aged 35-78 years, 32 respondents were male (69.6%), with an average duration of professional practice of 29.2 years. Five thematic findings, guided by the multidimensional supportive care needs model, were identified, including symptom management as central to end-of-life care, verbal consolation as ancillary services, the absence of spiritual care, social support and economic assistance, and a lack of informational resources and support. Village doctors have focused primarily on symptom management and basic medical care and have contended with limited resources, strict regulations on narcotic drugs, and cultural taboos against death. Serving as frontline healthcare providers, they navigated complex familial decision-making, offered indirect psychological support, and often avoided direct discussions about terminal prognoses.

conclusionDespite these challenges, village doctors' deep community roots and trusted relationships ensure continuity and cost-effective end-of-life care. Enhancing their role through improved training and policy support could markedly optimize care quality and accessibility in rural China, addressing disparities and promoting dignified care for patients and their families.