"Family-as-Root" and "Family-Centeredness" in hospice care: a concept analysis and implications for nursing practice.

backgroundFamilies are widely recognised as central actors in hospice and palliative care, and “family-centered care” has become a dominant practice model. However, the ontological and axiological status of the family in many cultural contexts—particularly East Asian Confucian traditions—extends far beyond the functional roles usually described by family-centeredness. This study conceptualizes and clarifies “Family-as-Root” - a culturally grounded, ontological-axiological orientation to family that is widely recognizable in Chinese contexts but remains under-theorized in international hospice literature - and distinguishes it from, while relating it to, “Family-Centeredness” in hospice care.

methodsWe conducted a concept analysis using Walker and Avant’s eight-step method, treating “Family-as-Root” as an analytical term developed to capture conceptual gaps not fully addressed by existing family-centered paradigms. A systematic literature search of major English- and Chinese-language databases (PubMed, PsycINFO, CINAHL, Web of Science, CNKI, and Wanfang Data) was undertaken from inception to August 2025. The corpus included theoretical, empirical and review articles addressing families in hospice or palliative care, end-of-life decision-making, and family-related cultural values. Through iterative reading and coding, we identified defining attributes, antecedents and consequences of “Family-as-Root” and “Family-Centeredness”, and constructed model, borderline and contrary cases to illustrate their manifestations in practice.

resultsThe analysis showed that “Family-as-Root” is an ontological–axiological construct grounded in a view of the person as inherently embedded in intergenerational family relationships. It emphasises the family as the primary locus of identity, value transmission, moral obligation and meaning-making in serious illness and dying. By contrast, “Family-Centeredness” is a functional care paradigm that focuses on collaborative decision-making, information sharing, and role negotiation between professionals, patients and family members within existing healthcare structures. In hospice care, these two concepts intersect but are not interchangeable: Family-as-Root shapes how patients and relatives understand suffering, good death and acceptable choices, while Family-Centeredness structures how professionals engage families in care processes. Recognising this distinction highlights expanded nursing roles as interpreters of cultural values, facilitators of intra-family dialogue, and safeguards of patients’ and families’ sense of meaning.

conclusions“Family-as-Root” and “Family-Centeredness” represent two interrelated but conceptually distinct dimensions of family involvement in hospice care—one ontological–axiological, the other functional–interactional. Differentiating these concepts can support the design of culturally sensitive hospice models, guide assessment of family needs and resources, and inform the development of nursing interventions and measurement tools that more adequately reflect diverse family cultures in China and other settings.