Healthcare Professionals’ Perspectives on End-of-Life Care for Metastatic Prostate Cancer in Aotearoa New Zealand: A Reflexive Thematic Analysis

Abstract

Background: Metastatic prostate cancer (mPCA) is an incurable, life-limiting illness that presents significant physical, emotional, spiritual, and relational challenges to patients and their whānau. Despite growing research on end-of-life (EOL) care, there remains a limited understanding of how healthcare professionals (HCPs) in Aotearoa New Zealand (NZ) navigate the relational, cultural, emotional, and structural complexities of providing EOL care.

Method: The study investigated experiences of HCPs providing EOL care to men living with mPCA. Seven HCPs representing oncology, hospice, primary care, community nursing, psychology, and theranostics participated in semi-structured interviews. The data were analysed using reflexive thematic analysis.

Findings: Participants understood EOL care as a relational, culturally situated, and systemically influenced experience. Four interconnected themes were identified: (1) Whanaungatanga – Relational Care and Whānau Involvement at End of Life; (2) Wairuatanga and Manaakitanga – Cultural Responsiveness and Making Meaning of End-of-Life; (3) Rangatiratanga – Autonomy, Identity, and Ethical Care; and (4) Ōritetanga (Equity) – Structural Inequities and Access to End-of-Life Care. Across the interviews, participants identified challenges in balancing clinical responsibilities with the emotional, spiritual, and cultural needs of patients and whānau while navigating difficult workforce pressures, fragmented service delivery, and inequitable access to care.

Conclusion: The quality of EOL care provided to men living with mPCA is influenced by relationships, shared decision-making, spirituality, meaning-making, and culturally responsive care. However, workforce pressures, fragmented services, and persistent inequities within health systems hinder the delivery of whānau-centred care. Improving the equitable provision of EOL care requires investment in workforce wellbeing, service integration, culturally responsive practice, and addressing ongoing inequities within the healthcare system. Further research involving Māori and Pacific HCPs is needed to enhance understanding of culturally responsive EOL care in NZ.