"Why wouldn't we want to do this?" The challenge for oncology hospital nurses to engage in serious illness conversation and advance care planning.

• Limited skills and fears hinder advance care planning discussions with patients. • Filial piety in Eastern cultures complicates patient autonomy in ACP. • Emotional discomfort and cultural stigma impede effective ACP implementation. • Legal uncertainties and lack of teamwork pose obstacles to optimal ACP practices. • Urgent need for strategies overcoming barriers and promoting patient-centered ACP. The viability of advance care planning (ACP) in cultures where discussing future desires is taboo is unclear, it is essential to examine the challenges faced by Chinese nurses lacking legal protection for ACP. To comprehend Chinese oncology nurses' perceptions of serious illness conversation and ACP, and identify barriers to engagement. A qualitative descriptive exploratory study involving semi-structured interviews with 13 experienced oncology nurses, analyzed using thematic analysis and critical incident technique, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Four themes emerged: Inadequate Competence Causes Patient Harm, Cultural Influences to Patient Autonomy, Psychological Tolerance Neglects Best Interests, and Systemic and Legal Uncertainties Impact Patient Rights. Policy changes supporting nurses in ACP implementation, a 'whole-system strategic approach' involving legislative changes, organizational support, and public awareness are crucial for optimizing ACP and meeting diverse patient needs. [ABSTRACT FROM AUTHOR]