The implementation of palliative care in China faces distinct cultural challenges, including death taboos, indirect communication styles, and family-centered decision-making. This retrospective study utilized Interpretative Phenomenological Analysis to conduct a qualitative investigation of a terminal cancer patient’s process of receiving culturally adapted palliative care. The study identified three critical mechanisms that effectively balanced relational harmony with patient autonomy: (1) a guided card game facilitating autonomous decision-making; (2) spiritual dialogues facilitating self-discovery and transformation; and (3) a communal concert balancing individual expression with relational harmony. The study demonstrates that palliative care interventions adapted based on the concept of “relational autonomy” can effectively support a Chinese patient’s autonomy and personal transformation while maintaining family relational harmony, providing valuable insights for culturally adapted end-of-life care practice in China.