Abstract Objective To analyze the evolution of palliative care policies in China, identify trends in policy changes, and offer recommendations for policy optimization and enhancement. Methods This study utilized content analysis and social network analysis, employing ROST CM6 software to examine relevant palliative care policy documents. The analysis aimed to identify focal points of policies at different stages and to explore patterns of policy evolution within the context of the social governance system. Results Over time, the number of palliative care policy documents has increased. Policy goals have evolved from focusing on controlling physical symptoms of terminal patients to establishing an integrated and continuous elderly health service system encompassing both urban and rural areas, including palliative care. The target population has expanded from cancer patients to individuals in the terminal stages of various diseases. Policy content has progressed from basic end-of-life care services to a systematic approach that includes innovating service models, building professional multidisciplinary teams, expanding pilot implementations, deepening medical insurance reforms, and enhancing supporting measures. Additionally, the responsibility for policy implementation has shifted from being solely government-led and executed by medical institutions to encouraging participation from the entire society Conclusions Palliative care policies in China demonstrate trends of broader participation, expanded coverage, enriched content, and improved systems. However, challenges remain, including the absence of targeted policies, inadequate implementation measures, and insufficient security provisions. Strengthening top-level design and establishing a comprehensive palliative care policy system are necessary to address these issues.