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.