The family is universally acknowledged as a pivotal stakeholder within hospice and palliative care, establishing “family-centered care” as a prominent framework for clinical practice. Nevertheless, the existential and value-based status of families across various cultural landscapes—most notably in East Asian Confucian heritages—extends far beyond the pragmatic responsibilities typically associated with a family-centered approach. The present study delineates and clarifies the concept of “Family-as-Root,” an ontologically and axiologically grounded orientation toward kinship that is deeply recognizable within Chinese societies but remains under-theorized within international end-of-life literature. Furthermore, this study differentiates this construct from and explores its relationship to “Family-Centeredness” in palliative care settings. A formal concept analysis was conducted using the eight-stage methodology formulated by Walker and Avant, treating “Family-as-Root” as an analytical framework to capture existential dimensions not fully addressed by current family-centered paradigms. A comprehensive literature search was performed across primary English- and Chinese-language databases (including PubMed, PsycINFO, CINAHL, Web of Science, CNKI, and Wanfang Data) spanning from database inception to August 2025. The analyzed corpus comprised theoretical, empirical, and review literature focusing on family dynamics in hospice or palliative care, end-of-life decision-making processes, and family-oriented cultural ethics. Through a process of progressive reading and thematic coding, we characterized the defining attributes, precursors, and outcomes of both “Family-as-Root” and “Family-Centeredness,” while formulating model, borderline, and contrary cases to illustrate how these concepts manifest in clinical scenarios. The conceptual analysis indicated that “Family-as-Root” serves as an ontological-axiological framework grounded in a perspective in which the individual is fundamentally integrated into multi-generational family networks. This construct highlights the family unit as the foundational core of personal identity, generational value transmission, moral responsibility, and existential meaning-making during advanced illness and the dying process. Conversely, “Family-Centeredness” operates as a functional model of care focused on cooperative decision-making, information dissemination, and role negotiation among healthcare providers, patients, and relatives within established medical infrastructures. Within the realm of hospice care, these dual concepts intersect but are not interchangeable: Family-as-Root governs how patients and their kin perceive suffering, a dignified death, and viable choices, whereas Family-Centeredness organizes the mechanisms by which professionals engage with families during care delivery. Recognizing this demarcation underscores expanded nursing competencies, positioning clinicians as cultural translators, mediators of intra-family dialogue, and protectors of the patient and family’s existential experience. “Family-as-Root” and “Family-Centeredness” constitute two interconnected yet conceptually separate dimensions of family engagement in palliative care—the former being ontological-axiological and the latter functional-interactional. Distinguishing between these frameworks can facilitate the formulation of culturally congruent hospice care models, improve the evaluation of family needs and strengths, and inform the development of nursing interventions and assessment instruments that more accurately capture diverse familial cultures within China and globally.
