Why “Family First” Matters in Palliative Care for Chinese Migrants

Te Ārai PhD student Xuan Wang, lead author of a new review exploring palliative care for Chinese migrants

The importance of family first

When palliative care services are designed, they often assume a particular model of decision‑making, communication, and care delivery, one that prioritises individual autonomy, open disclosure, and formal service provision. For many migrants, however, these assumptions do not reflect lived realities.

Our recent integrative review, led by PhD student Xuan Wang, explores how Chinese migrants and their families experience palliative care, and why a deeply held value - “family first” - plays a central role in shaping those experiences.

Migration, culture, and palliative care

Globally, migration is increasing, and health systems in high‑income countries are caring for ever more diverse populations. Yet migrants continue to experience inequitable access to palliative care, including later referrals, lower uptake of services, and higher reliance on acute hospital care at the end of life.

Chinese migrants are one of the largest migrant populations worldwide. While previous research has often pointed to “cultural beliefs” as explanations for disparities, far less attention has been paid to how migration itself interacts with culture to shape experiences of serious illness and dying.

Our review brings these strands together, asking: How do cultural values and migration experiences shape Chinese families’ experiences of palliative care?

What we reviewed

We conducted an integrative literature review, bringing together qualitative and quantitative studies from countries including Canada, Australia, the United States, and Aotearoa New Zealand. Eleven papers met our inclusion criteria, capturing the perspectives of Chinese migrant patients and family members receiving palliative care across a range of settings.

Using thematic analysis informed by a cultural safety framework, four interconnected themes emerged.

Four experiences that shape care

1. Self‑isolation

Many Chinese migrants described deliberately limiting requests for help or withdrawing from social support. This was not a lack of need, but a moral choice: asking for help was seen as burdening others, particularly adult children who were already managing work, finances, and their own families.

Self‑isolation became a way of protecting the family, sometimes shared by couples together, rather than an individual act of disengagement.

2. Far from help

Families often felt they were managing alone. Extended family members and trusted social networks were frequently in another country, while language barriers and limited system knowledge made it hard to access local services. Family members took on multiple roles, including caregiver, interpreter, and care coordinator, alongside their existing responsibilities.

The result was a profound sense of being “far from help,” both practically and emotionally.

3. Sociocultural shifts through migration

Migration introduced new tensions. First‑generation migrants often held expectations shaped by healthcare systems in China, where hospital‑based care and family managed decision‑making are more common. These expectations sometimes clashed with Western palliative care norms around disclosure, home death, and individual choice.

Language barriers intensified these challenges, and family members frequently filtered or softened information to protect patients from distress.

4. Trust problems arising from migrant experience

Trust in palliative care services was closely tied to trust in the host country’s healthcare system more broadly. Unfamiliar systems, past experiences of discrimination, contradictory information from overseas sources, and unmet expectations all contributed to uncertainty and skepticism.

In response, many families sought advice from doctors, friends, or relatives in their country of origin, sometimes increasing confusion rather than reducing it.

“Family first” as the connecting thread

Across all four themes, one principle consistently shaped decisions and actions: family first.

Rooted in Confucian family ethics, this value positions the individual within an interdependent family unit. Decisions are made with the perceived wellbeing of the family as a whole in mind, not just the preferences of the individual patient. Importantly, family first is not the same as family‑centred decision‑making as defined in Western healthcare. It is not a process facilitated by clinicians, but a deeply embedded moral orientation enacted by patients and families themselves.

In the context of migration, this value is often strengthened. With fewer external supports, families rely more heavily on one another, intensifying shared responsibility and mutual protection.

Our paper proposes a “family‑first model” to make this dynamic visible and meaningful for clinicians and policymakers.

Why this matters for practice

If palliative care services fail to recognise the centrality of family first, well‑intentioned care can still feel unsafe, alien, or exclusionary. A focus on individual autonomy alone may overlook the relational, ethical, and practical realities shaping decision‑making for Chinese migrant families.

Practising cultural safety—rather than simply cultural competence—means reflecting on whose values are embedded in care models, and whose are marginalised. It also means recognising migration itself as a social determinant of health.

Operationalising a family‑first approach might include:

• early and ongoing engagement with family members

• flexible communication practices that attend to language and trust

• multidisciplinary meetings that include families as partners in care

• critical self‑reflection by clinicians on power, assumptions, and norms

Looking ahead

Most existing research focuses on barriers and difficulties. While these are important, future work also needs to explore what enables good palliative care experiences for Chinese migrants and their families, and how health systems can learn from family‑based strengths rather than framing them as obstacles.

As migration continues to shape populations worldwide, designing palliative care that responds to both culture and migration is not optional—it is essential for equity, trust, and humane care at the end of life.

Click below to read a full text version of the paper: