Abstract
OBJECTIVE: This study investigates the mechanisms underlying decision-making for palliative treatment in patients with advanced gynecological cancer, focusing on their subjective experiences and the interplay of emotional, cognitive, social, and cultural factors that shape these decisions, thereby complementing existing research on the role of palliative care. METHODS: Between April and October 2023, 14 inpatients with advanced cervical, ovarian, or endometrial cancer at a tertiary hospital in Guangdong underwent in-depth, semi-structured interviews. The data were analyzed using Strauss and Corbin's grounded theory approach, which involved open, axial, and selective coding to ensure theoretical saturation. RESULTS: Three core categories were identified: decision intention (influenced by family support, trust in providers, and disease cognition); decision conditions (including physical status, economic burden, quality-of-life goals, and cultural perceptions); and decision outcomes (which varied with prognostic expectations, prioritization of family interests, reflecting Chinese collectivism). CONCLUSIONS: Palliative decision-making is complex and culturally embedded. The findings emphasize the necessity for patient-centered communication, sensitivity to sociocultural subtleties, and customized decision-support systems to facilitate informed choices and enhance the quality of care.