目的 探讨恶性肿瘤终末期患者临终抢救决策偏好及影响因素，为优化临终照护与安宁疗护提供依据。 方法 采用便利抽样，选取2023年9月至2024年11月四川大学华西医院肿瘤科住院的485例终末期恶性肿瘤患者，采用结构化问卷收集其人口学特征、决策相关资料、抢救偏好及文化信仰水平。 结果 在病情危重情境下，39.4%患者选择积极抢救，33.6%放弃，27.0%倾向维持治疗；对9项具体生命维持治疗措施的接受度在28.9% ~ 61.2%之间。多因素logistic回归显示，文化信仰得分高、年龄较小、有配偶、主要照顾者为配偶、职工医保及携带管道是倾向积极或维持治疗的主要因素（P < 0.05）；首要考虑生活质量或经济压力则与倾向放弃抢救相关（P < 0.05）。 结论 终末期恶性肿瘤患者临终抢救偏好多样化，受文化信仰、人口学特征及家庭照护显著影响。临床应结合患者价值观、文化背景与个体需求，提供分层化决策辅助，促进理性且符合患者价值取向的医疗选择。

Objective To explore the preferences and influencing factors of terminal malignant tumor patients， and to provide a basis for optimizing hospice care. Methods A convenience sampling method was employed to select 485 patients with terminal malignant tumors from the oncology departments of two tertiary， class-A hospitals in Sichuan Province between September 2023 and November 2024. Data on demographic characteristics， decision-making-related information， preferences regarding resuscitation， and cultural belief levels were collected using a structured questionnaire. Results In critical situations， 39.4% of patients opted for active rescue， 33.6% chose to forgo treatment， and 27.0% preferred to maintain current treatment. Acceptance rates for nine specific interventions ranged from 28.9% to 61.2%. Multivariate logistic regression analysis revealed that stronger cultural beliefs， younger age， having a spouse， being the primary caregiver， employee medical insurance coverage， and use of invasive tubes were significantly associated with a tendency toward active or continued treatment （P < 0.05）. Prioritizing quality of life or concerns about economic burden were significantly associated with the decision to forgo life-sustaining interventions （P < 0.05）. Conclusions Patients with terminal malignant tumors exhibit diverse preferences regarding end-of-life resuscitation， significantly shaped by cultural beliefs， demographic factors， and family support. Clinicians should integrate patients’ values， cultural backgrounds， and individual needs to provide tiered decision-making support， thereby facilitating medically appropriate and value-concordant care choices.