Abstract / Summary
Paediatric end-of-life care in mainland China occurs within contexts shaped by death taboo, protective silence, and the uneven development of palliative care services. Drawing on interviews with paediatric palliative care professionals, this qualitative study explored professionals’ accounts of how children and families receiving paediatric palliative care made sense of illness, dying, and bereavement, as well as the factors perceived to shape these meaning-making processes. Using reflexive thematic analysis of 34 in-depth interviews with 24 professionals involved in paediatric palliative care, we examined how meaning-making is negotiated under communicative constraints. We describe five interrelated domains of experience through which meaning-making was negotiated: silence and taboo surrounding end-of-life experiences; tension, disruption, and reconfiguration of interpersonal relationships; encountering grief, despair, and loss of control; negotiated and fragmented meaning-making; and constrained and disrupted bereavement practices. Across these domains, professionals described how children and families attempted to make sense of illness, dying, and bereavement through relational, symbolic, and mediated forms of meaning-making, while navigating restricted opportunities for open communication, preparation, and remembrance. Findings extend existing meaning-making perspectives by showing that, in culturally and institutionally constrained paediatric end-of-life care, meaning may remain provisional and fragmented, negotiated indirectly through silence, symbolic practices, emotional accompaniment, and professional mediation rather than through explicit disclosure or individual cognitive resolution.