Physicians and nurses at a large hospital in Shenzhen, China, perceive a cluster of interlocking barriers that stand in the way of effective palliative care communication, according to a qualitative study published in BMC Palliative Care. The research team, led by Sijia Zhou and Weixiang Luo, interviewed twenty clinicians working in palliative care-related departments and mapped their accounts onto the Theoretical Domains Framework, a widely used behavioural science tool for organising the determinants of clinical practice. Their analysis yielded six overarching barrier themes: insufficient understanding and lack of communication skills, decision-making difficulties, lack of resources for palliative care, sociocultural resistance, emotional strain, and a lack of communication support mechanisms.

The study was conducted between December 2025 and February 2026 at a tertiary Grade A hospital in Shenzhen. The researchers used purposive sampling to recruit twelve nurses and eight physicians from departments related to palliative care. Each participant took part in a semi-structured, face-to-face interview that was audio-recorded with consent and transcribed verbatim within twenty-four hours. The team managed the interview data in NVivo 14 and identified barriers through framework analysis combined with thematic development, an approach that allowed them to code participants’ accounts against predefined theoretical categories while remaining open to patterns emerging from the data itself.

The Theoretical Domains Framework, or TDF, integrates behavioural determinants identified across implementation science literature into a structured set of domains, offering researchers a systematic way to examine why evidence-based practices are not adopted in clinical settings. In this study, the interview data were mapped onto six TDF-derived analytic groupings, with the domains of knowledge and skills combined into one. These groupings spanned seven of the fourteen original TDF domains. Data corresponding to the remaining domains were retained in the overall analysis but were not presented as standalone themes, because the accounts relating to them were sparse or fragmented.

The six barrier themes broke down into thirteen subthemes. The first theme, insufficient understanding and lack of communication skills, reflects accounts in which clinicians described gaps in their grasp of palliative care communication and in the practical abilities needed to hold difficult conversations with patients and families. The second theme, decision-making difficulties, captures the challenges clinicians faced when navigating choices about what to communicate, when, and to whom, particularly in situations involving serious illness where the right course of conversation is far from obvious.

The third theme concerned a lack of resources for palliative care. Participants indicated that shortages of material, staffing and organisational support constrained their ability to communicate in the way they considered appropriate. The fourth theme, sociocultural resistance, points to the influence of social and cultural norms on palliative care conversations, an area the authors highlight as a distinct layer of difficulty beyond individual knowledge or skill. Such resistance can shape what clinicians feel able to say and how families receive the information offered to them.

Emotional strain formed the fifth theme. Clinicians described the emotional burden of palliative care communication, a burden that the study treats as a barrier in its own right rather than a background condition. The sixth theme, lack of communication support mechanisms, refers to the absence of structured organisational backing for these conversations, such as systems and processes that would otherwise help clinicians carry out communication tasks consistently.

The authors frame these findings as a step toward intervention development. In their conclusions, they state that physicians and nurses perceived barriers related to knowledge and skills, decision processes, resources, social influences, emotional strain and communication support, and that the TDF helped organise these accounts and identify candidate targets for locally adapted interventions. They are explicit that the feasibility and effects of such interventions require further evaluation; the study identifies targets, not tested solutions.

Several features of the study design shape how the findings should be read. The sample comprised twenty clinicians from a single tertiary Grade A hospital in one Chinese city, recruited through purposive sampling, so the accounts reflect the perceptions of a specific group in a specific setting rather than a nationally representative picture. The study ran for three months, from December 2025 to February 2026, and relied on semi-structured interviews, meaning the data capture what clinicians said about their experiences rather than direct observations of communication in practice. The article was published as open access research on 4 November 2026, and the version shared at publication is an accepted manuscript subject to further edits before the final Version of Record replaces it.

Within those limits, the study offers a structured account of where palliative care communication stalls in one high-acuity Chinese hospital. By anchoring the analysis in the TDF, the researchers connected individual-level factors, such as knowledge, skills and emotional strain, with organisational and sociocultural factors, such as resources, social influence and the absence of support mechanisms. That combination matters for intervention design, because barriers spread across these levels are unlikely to yield to training alone. The authors position the six themes and thirteen subthemes as candidate targets for locally adapted interventions, an approach that treats the specific configuration of barriers in a given department, rather than a generic checklist, as the starting point for change. Whether addressing these targets improves communication in practice remains a question for future evaluation studies.

Subject of Research: Barriers to palliative care communication perceived by physicians and nurses at a Chinese tertiary hospital

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

Article References: Zhou, S., Lian, J., Luo, T., Luo, Y., Li, Z., Yang, X., Shen, Y., & Luo, W. (2026). Perceived barriers to implementing palliative care communication among healthcare professionals: a qualitative study based on the theoretical domains framework. BMC Palliative Care. https://doi.org/10.1186/s12904-026-02416-2

Image Credits: AI Generated

DOI: 10.1186/s12904-026-02416-2

Keywords: palliative care, communication, qualitative research, Theoretical Domains Framework, physicians, nurses, barriers, implementation science, tertiary hospital, China, semi-structured interviews, framework analysis