Practice and Strategies of Palliative Care Physicians' Agency: An Integrated Narrative and Observational Study.

Objective To explore how physicians exercise agency in palliative care under cultural,technological,and institutional constraints. Methods This study integrated death narratives with participatory observation in a palliative care center of a tertiary hospital in Beijing and systematically analyzed the data by reflexive thematic analysis. Results Physicians faced three structural constraints:medical familism at the cultural level,which hindered information sharing and patient autonomy;a technology-first tendency leading to overtreatment and misaligned goals;and institutional resource shortages with marginalized values.In response,they employed three key agency strategies:acting as communication mediators to build trust;serving as decision navigators to refocus families on patient interests;and coordinating care networks to address psychosocial and spiritual needs. Conclusions Physicians demonstrate contextual and strategic agency in palliative care,creating space to improve care under structural constraints.This study provides empirical support for localized practice and highlights the need for institutional reinforcement of physician agency.