A longitudinal qualitative study on the psychological changes and coping mechanisms of palliative care volunteers serving patients undergoing maintenance haemodialysis

About 850 million people globally suffer from chronic kidney disease (CKD). In China, the prevalence of CKD among adults aged 18 years and older is 8.2%, with more than 1 million patients receiving dialysis therapy. Despite this burden, palliative care for advanced CKD remains underdeveloped in China. Cultural taboos around death, misconceptions about palliative care, and limited support systems for volunteers hinder service delivery. Consequently, volunteers face both resistance from patients and families and considerable psychological stress associated with long-term exposure to suffering and end-of-life care. To develop a conceptual framework for the psychological changes and coping strategies of palliative care volunteers during one year of service to patients undergoing maintenance haemodialysis (MHD). Longitudinal qualitative interview study. Conducted between March 2023 and September 2024, this study recruited 16 palliative care volunteers (non-clinical interdisciplinary team members who completed standardized palliative care training and provide supportive care for patients undergoing MHD) with diverse demographic and professional backgrounds from Peking Union Medical College Hospital’s Blood Purification Center. Semi-structured interviews were conducted at 1, 3, 6, and 12 months of service; data saturation was achieved through longitudinal purposive sampling and grounded theory-guided concurrent data analysis, with reporting aligned to the COREQ checklist for qualitative research. Palliative care volunteers experienced psychological changes in three phases while serving patients undergoing MHD: (1) belief collapse (2), value reconstruction, and (3) strengthening growth. At each stage, volunteers adopted different coping strategies, reflecting a shift from passive to active involvement and from superficial to deeper engagement. This 12-month longitudinal qualitative study identifies a three-stage dynamic model of psychological changes and stage-specific coping strategies among palliative care volunteers supporting patients undergoing MHD in their first year of service. The findings provide an evidence-based, stage-aligned framework to optimize volunteer training and management, advance standardized MHD palliative care volunteer programs in mainland China, and inform targeted support to help volunteers navigate service-related challenges.