Background <p>Palliative care training is essential for strengthening workforce capacity, yet little is known about training needs, barriers, and practice translation in ethnic minority regions. In China, these regions are often marked by cultural diversity, geographical remoteness, limited resources, and uneven health-system capacity, all of which may shape how palliative care training is accessed, delivered, and used in practice. This study explored palliative care training needs, barriers, and practice translation across multiple ethnic minority regions in China.</p> Methods <p>A qualitative study was conducted using focus group discussions in nine ethnic minority regions of China between January 2024 and March 2025. Purposive sampling was used to recruit 65 participants from seven stakeholder groups, including healthcare professionals, hospital teaching directors, trainers, researchers, hospital managers, primary healthcare managers, and policy makers. Eight mixed-stakeholder focus groups were conducted. Data were analysed using reflexive thematic analysis.</p> Results <p>Four interrelated themes were identified. First, access to training was constrained by structural factors, including limited opportunities, uneven distribution of resources, workforce shortages, and weak institutional and policy support. Second, existing training was often poorly aligned with local realities, having been developed largely for mainstream settings and insufficiently adapted to local cultural, linguistic, religious, and service contexts. Third, training was difficult to translate into routine practice because of weak service conditions, limited multidisciplinary support, and the absence of sustained organisational reinforcement.Fourth, participants identified training needs for culturally responsive, practice-oriented, and locally grounded capacity-building approaches, supported by local trainers, local teams, and longer-term reinforcement mechanisms.</p> Conclusions <p>Palliative care training needs and barriers in ethnic minority regions of China extend beyond limited training provision alone. They are shaped by the intersection of structural constraints, inadequate contextual adaptation, and difficulty translating learning into practice. Strengthening training in these settings will require more than expanding course provision; it will require culturally responsive, practice-oriented, and sustained forms of local capacity building. These findings may also inform palliative care training development in other resource-constrained, culturally diverse, and remote settings.</p> Trial registration <p>Not applicable.</p>