Abstract
INTRODUCTION: This study aimed to assess the current status and identify the key determinants of hospice care involvement among rural doctors in Guangxi, China, using Self-Determination Theory (SDT) as a framework. METHODS: A cross-sectional survey was conducted among 368 rural doctors from August to September 2024, with 312 valid responses (84.8% response rate). Data were collected using an online questionnaire assessing hospice care knowledge, willingness to provide care, and SDT-related psychological needs (autonomy, competence, and relatedness). Chi-square tests and ordinal logistic regression were used for analysis. RESULTS: Respondents demonstrated moderate knowledge of hospice care (8.9% comprehensive) but relatively high willingness (21.7% highly willing). The primary services provided included psychological support (75.0%) and companionship (59.6%). Multivariate analysis revealed that higher knowledge levels were positively associated with greater willingness to participate in research. Paradoxically, lower educational attainment (high school/associate degree vs. bachelor's degree) was a significantly positive predictor of willingness (OR = 3.07, p = 0.002; OR = 2.88, p = 0.002). Other key determinants aligned with SDT-professional identity (relatedness) and manageable workload (autonomy)-were positive motivators, whereas perceived unfair medical liability risk and excessive workload were significant barriers. DISCUSSION: Rural doctors in Guangxi showed a promising willingness to engage in hospice care, but their involvement was significantly constrained by systemic and motivational factors beyond mere knowledge. Interventions grounded in the SDT-such as enhancing competence through targeted training, ensuring autonomy via workload management and legal safeguards, and fostering relatedness through professional support-are essential for leveraging this willingness and improving end-of-life care in rural China.