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Objective Palliative care enhances the quality of life for individuals with life-limiting illnesses, but frequent exposure to death and suffering poses emotional challenges for professionals. This study examines rumination’s role in the relationship between existential anxiety (EA) and professional quality of life (ProQOL) among palliative care professionals in India.Methods A mixed-method research design was employed. Quantitative data were collected from 500 palliative care professionals using the Event-Related Rumination Inventory, EA Questionnaire and ProQOL scale. In-depth interviews were conducted with 27 professionals with high rumination scores. Correlation and regression analyses were used for quantitative data, while thematic analysis was applied to qualitative data.Results Persistent rumination heightened mortality awareness, exacerbated EA and negatively impacted ProQOL. Rumination partially mediated the relationship between EA and ProQOL. Four key themes emerged: (1) brooding rumination, (2) reflective rumination, (3) impact of rumination on ProQOL and (4) impact of rumination on EA. Individual differences in rumination’s intensity and duration were notable.Conclusions Findings highlight cultural and contextual challenges faced by Indian palliative care professionals, underscoring the need for targeted mental health interventions. This study supports Sustainable Development Goals 3, 8 and 4 by advocating for healthcare worker well-being, job satisfaction and improved mental health training.