Background <p>China is experiencing rapid population ageing and increasing demand for palliative care. However, development remains uneven because of fragmented policies, workforce shortages, limited public understanding, and sociocultural barriers. Existing studies have typically described these factors separately, offering limited insight into how they interact within complex health systems. This study aimed to examine the dynamic interactions among facilitators and barriers shaping palliative care development in China, informed by Wu-Xing theory.</p> Methods <p>We conducted a multi-method qualitative study across hospitals, palliative care institutions, and community settings in multiple regions of China between January 2024 and November 2025. Purposive sampling was used to recruit 49 stakeholders. Focus group discussions involved 38 stakeholders, including healthcare professionals, policymakers, researchers, volunteers, and service-sector representatives, while field observations captured the experiences of 6 patients and 5 family members in palliative care settings. Data were analysed using reflexive thematic analysis, with Wu-Xing theory used as an interpretive framework to examine relationships among themes.</p> Results <p>Five interdependent factors shaped palliative care development in China: policy standards, professional development, promotion and outreach, public awareness, and ethical culture. Analysis suggested two linked cycles. The Generating Cycle described how policy standards supported professional development, professional development enabled promotion and outreach, promotion and outreach improved public awareness, public awareness nurtured ethical culture, and ethical culture in turn updated policy standards. The Controlling Cycle described how policy standards regulated promotion and outreach, promotion and outreach reshaped ethical culture, ethical culture rectified professional development, professional development recalibrated public awareness, and public awareness in turn updated policy standards, contributing to mutual adjustment across the system.</p> Conclusions <p>Palliative care development in China may be better understood as a dynamic health-system process rather than as a linear effort to address isolated barriers. The Wu-Xing framework provides a culturally grounded lens for examining how policy, workforce capacity, communication, public attitudes, and ethical norms interact. These findings highlight the need for more integrated and context-sensitive strategies to strengthen palliative care in China.</p> Trial registration <p>Not applicable.</p>