Background <p>Palliative care is an important approach to relieving suffering and improving quality of life for people living with serious illness. Yet its development remains challenging in many low- and middle-income countries, particularly among vulnerable populations such as ethnic minorities. In ethnic minority regions of China, the palliative care implementation is shaped by distinctive social-cultural and practical realities. This study aims to systematically develop the major barriers and to generate actionable recommendations to policymakers to facilitate the advancement and implementation of palliative care in these regions.</p> Methods <p>A qualitative approach was conducted using seven focus group discussions with 56 participants drawn from key stakeholder groups, including healthcare providers, policymakers, patients, and community workers. Data were analysed using reflexive thematic analysis.</p> Results <p>Six interrelated themes were developed: palliative care at the margins of local health systems, shortage of trained professionals, policy endorsement without local traction, palliative care as giving up rather than caring differently, linguistic distance and fragile therapeutic communication, and families carrying the burden of system absence. These themes suggested that the limited development of palliative care in ethnic minority regions of China reflected not only resource constraints, but also weak system integration and insufficient alignment with local sociocultural, linguistic, and caregiving realities.</p> Conclusions <p>Advancing palliative care in ethnic minority regions requires improvements in essential resources, workforce training, culturally sensitive communication, and social support systems. The findings provide policy relevant insights for China and may also inform palliative care development in other low- and middle-income settings with underserved ethnic minority populations.</p> Trial registration <p>Not applicable.</p>