A qualitative study on the decision-making process regarding advance directives for patients undergoing palliative care

This study aims to explore the decision-making processes of patients who wish to make advance directives regarding their end-of-life care. It seeks to provide guidance for these patients during the process of making such decisions. From July to November 2025, interviews were conducted with 12 patients in palliative care units at three hospitals in Nanjing, Jiangsu Province. The data collected during these interviews was analyzed using the grounded theory methodology. The results show that after three levels of coding, one central category was identified: the decision-making process for advance directives for palliative care patients. This process involves four stages: decision-making assessment, information gathering, decision execution, and final adjustment of the decision. Additionally, these decisions are influenced by two factors: motivation to make decisions and obstacles encountered during the decision-making process.