To determine the factors influencing palliative care utilisation in patients with advanced cancer and to assess its association with the quality of death (QOD).A cross-sectional study.This study was conducted in tumour hospitals in the Hunan and Sichuan provinces of China. In 2021, the country launched a 'palliative care standard wards' project, identifying 16 medical institutions as the first pilot sites.Deceased patients who met the admission criteria for a standard palliative care unit were the study subjects, and their caregivers were recruited for questionnaires.No interventions were applied in this study.A self-reported questionnaire survey was administered to caregivers of deceased patients with advanced cancer in mainland China. Binary logistic regression was used to identify factors influencing palliative care utilisation. The association between utilisation of palliative care and the QOD was tested using an independent samples t-test.Of 947 patients, 342 (36.1%) received palliwiative care. Data were collected from 400 caregivers (42.2%). Palliative care utilisation was associate with intrusion operation (adjusted OR (aOR): 1.7, 95% CI: 1.05 to 2.92, p=0.032) and relationship with patients caregiver age (aOR=6.5, 95% CI: 3.6 to 12.7, p<0.001). Additionally, longer caregiving duration, high school or junioreducational level (aOR:=0.5, p=0.024), and caregiver retirement status were associated with palliative care utilisation. Patients receiving palliative care scored higher on the Good Death Inventory (96.2 (13.0) vs 107.22 (9.6), t = -9.8, p<0.000). The most significant differences were observed in the dimensions of 'passing away in a place that meets the patient's wishes,' 'unawareness of death' and 'remaining hopeful and happy.'Patient and caregiver characteristics influence palliative care utilisation, and use of palliative care contributes positively to most dimensions of the QOD. Future research should further explore multiple factors influencing palliative care utilisation and examine whether they contribute to the QOD.© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.