# Analyzing the current situation and influencing factors of rural doctors’ intervention in hospice care services in Guangxi

## TL;DR

This study explores how rural doctors in Guangxi, China, are involved in hospice care and what factors influence their willingness to participate.

## Contribution

The study applies Self-Determination Theory to identify novel motivational and systemic factors influencing rural doctors' hospice care involvement.

## Key findings

- Rural doctors showed high willingness (21.7%) to provide hospice care despite moderate knowledge.
- Lower educational attainment was paradoxically linked to higher willingness to participate.
- Professional identity and manageable workload were key motivators, while liability risks and workload were barriers.

## Abstract

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.

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.

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.

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.