“It’s about fulfilling my role”: a qualitative study of dignity and life narrative meanings for older adults in palliative care within a Confucian-family context

Dignity is a cornerstone of quality palliative care. While Dignity Therapy has been developed to support dignity, its cultural foundations are rooted in Western individualistic values. In Confucian-family contexts, where interdependence and familial roles are paramount, the conceptualization of dignity and the relevance of life narratives may differ significantly. Understanding these culturally embedded perspectives is crucial for developing person-centered care that is truly resonant. This study aimed to explore how older adults in a Confucian-family context perceive and articulate the concepts of dignity and the meaning of their life narratives during palliative care. A descriptive qualitative study was conducted. Purposive sampling was used to recruit 18 older adults (aged 70+) receiving palliative care from a hospital and a community care center in East Asia. Data were collected through in-depth, semi-structured interviews focusing on experiences of dignity, meaning in life, and family relationships. All interviews were transcribed verbatim and analyzed using reflexive thematic analysis within a constructivist paradigm. The analysis yielded three interrelated themes: (1) Dignity as Familial Role Fulfillment and Burden Avoidance; (2) Narratives as Legacy and Continuity; and (3) The Family as Co-author and Validator. Dignity was predominantly experienced through fulfilling familial roles, contributing to harmony, and avoiding being a burden. Life reviews focused on imparting values and history to ensure family continuity. The meaning-making process was inherently social, requiring family acknowledgment to validate the narrative and sustain dignity. This study reveals that for older adults in a Confucian-family context, dignity and life narrative meaning are fundamentally relational and family-centric. These findings challenge the direct application of individualistically framed dignity interventions. They highlight an urgent need for culturally adapted approaches to narrative care in palliative nursing that actively incorporate familial roles and intergenerational bonds, moving beyond the individual patient to engage the family system as a unit of care. Not applicable.