People with cancer from culturally and linguistically diverse backgrounds often struggle to get palliative and end-of-life care that matches what they actually want, and a new systematic review has mapped out why. The review, published in Supportive Care in Cancer, synthesized two decades of research on the needs and preferences of patients from culturally and linguistically diverse (CALD) backgrounds, a term used in Australia to describe people with non-Western languages, ethnic backgrounds, traditions, societal structures, and religions, as well as those born outside main English-speaking countries. Its central message is that care at the end of life is shaped not only by medicine but by family, faith, and how well patients understand the health system around them.
The research team searched five electronic databases, Medline, PsycInfo, CINAHL, Embase, and Scopus, for peer-reviewed primary studies published between January 2003 and September 2025. The strategy combined medical subject headings and keywords covering cultural and linguistic diversity, palliative and end-of-life care, cancer, voluntary assisted dying, and patient preferences, needs, and experiences. The protocol was prospectively registered on PROSPERO, and reporting followed the 2020 PRISMA guidelines. Quality appraisal used the Quality Assessment for Diverse Studies, a thirteen-domain checklist scored independently by three reviewers, with a kappa statistic used to measure agreement between them.
The numbers behind the review show how much screening such syntheses demand. A total of 6017 titles were identified; after removing 1257 duplicates, 4760 articles went through title and abstract screening, 153 articles underwent full-text review, and 20 studies made the final cut. Twelve were qualitative, six quantitative, and two used mixed methods. Fifteen studies came from the United States, with two from Canada and one each from the United Kingdom, Australia, and New Zealand. Fourteen studies reported end-of-life care encounters and six reported palliative care encounters, and the studies were split evenly between those examining care preferences and those exploring patient experiences.
From these studies, four core needs emerged. Patients wanted to maintain positivity in the face of illness, and many described protecting family members and caregivers from suffering as a key reason for engaging with end-of-life services. They also wanted to maintain decision-making autonomy, even while simultaneously needing family members involved in decisions. Trust in the provider-patient relationship was another recurring need, one that reviewers noted was often emphasized for Black and Latina patients by the lack of representation of their cultural background among their providers. Patients also valued clinicians who looked past cultural assumptions and implicit biases, and who created safe spaces where end-of-life options could be discussed openly.
Preferences, by contrast, varied widely, which is precisely the point the review drives home. One study found that African American, Hispanic, and Asian patients were more likely to prefer life-extending treatments, even at the cost of expending all their financial resources, though this preference was less common among older patients, those with multiple dependents, and those who believed they had less than five years to live. Patients with greater awareness that their illness was terminal were more likely to prefer supportive care. Despite a greater perceived need for hospice among African American patients, they were less likely to choose hospice services, and White patients were more likely to have discussed end-of-life preferences and to hold living wills or do-not-resuscitate orders.
Who makes the decisions proved equally nuanced. Some patients preferred physicians to be the primary decision-maker and reported that a lack of clinician initiative was a barrier to accessing end-of-life care, while others preferred to take the lead themselves. Regardless of that preference, patients generally wanted to be the ones to disclose information about diagnosis and prognosis to their family members and caregivers. The review also found that patients from minority backgrounds were often dissatisfied with their treating team when family members were not proactively involved in key conversations, a finding that underscores how deeply end-of-life care is a family affair for many people.
Family involvement cut both ways. Some African and Hispanic patients sought end-of-life care precisely to support their families through the dying process, and making decisions in advance allowed them to regain a sense of control and ensure their choices were honored. But families could also stand in the way. Reluctance to engage in what relatives saw as negative thinking kept some patients from using palliative services, and Hispanic patients were often reluctant to enter end-of-life conversations at all, downplaying their struggles and desire for support so as not to burden their families. Among African Americans, discrepancies between patient and family preferences for life-sustaining treatment were sometimes impossible to resolve through discussion alone.
Faith and spirituality played an equally complicated role. Religious and spiritual coping was frequently reported as a barrier to seeking palliative care among African American, Asian, Pacific Islander, and Hispanic patients, rooted in beliefs about divine intervention, God providing a cure, or the idea that non-life-sustaining treatment would act against God’s will, and these patients often showed a strong preference for aggressive care. Yet the same faith could point in the opposite direction: among African American and Latina patients who believed their physicians acted as the hand of God, the preference was to follow the physician’s suggestion to use palliative care. Among African American patients more broadly, spirituality was also a resource for coping with a cancer prognosis.
Perhaps the most fixable barrier was confusion about how services work. Many patients and families believed there were thresholds to meet before palliative care could be accessed, feeling they were not sick enough or poor enough to qualify, and they were often unfamiliar with the range and flexibility of services available. Some believed hospice was only a place rather than both an institution and a philosophy of treatment, and palliative care was frequently misunderstood as equivalent to end-of-life care or mutually exclusive from active treatment, something that implied giving up, hastening death, or foreclosing treatment possibilities. A lack of interpreter services and inadequate translation of palliative care terminology left patients feeling isolated, frustrated, and unheard, and the reviewers note that difficulties translating palliative concepts across languages may partly reflect how deeply those concepts are grounded in Western cultural values.
The review’s limitations matter for how its findings travel. Only three of the included studies showed evidence of stakeholder input into research design, and nearly half provided no or basic justification for their analysis methods. Only five of the twenty studies were conducted outside the United States, and most focused on African American or Hispanic populations, which limits generalizability to countries with different health systems and ethnic profiles. The authors excluded gray literature, non-English studies, and studies of Australian Indigenous peoples. Their conclusion is emphatic nonetheless: preferences within CALD groups are not monolithic, so themes should serve as starting points for conversation rather than prescriptive conclusions. System-level changes, including community consultation, clearer messaging about the role and flexibility of palliative care, and improved access to culturally and linguistically appropriate resources, are needed to make end-of-life care genuinely goal-concordant.
Subject of Research: Palliative and end-of-life care needs and preferences of culturally and linguistically diverse cancer patients
Article Title: What are the palliative and end-of-life care needs and preferences of people with cancer from culturally and linguistically diverse (CALD) backgrounds?: A systematic review
Article References: Naresh, S. S. S., Chauhan, A., Newman, B., & Harrison, R. (2026). What are the palliative and end-of-life care needs and preferences of people with cancer from culturally and linguistically diverse (CALD) backgrounds?: A systematic review. Supportive Care in Cancer, 34(11), Article 1171. https://doi.org/10.1007/s00520-026-11341-2
Image Credits: AI Generated
DOI: 10.1007/s00520-026-11341-2
Keywords: palliative care, end-of-life care, cancer, CALD backgrounds, systematic review, health equity, decision-making autonomy, family involvement, faith and spirituality, interpreter services, hospice, cultural barriers
News Source: Nathaniel Bowman. (October 29, 2026). Cancer patients from diverse backgrounds face cultural barriers at end of life. Scienmag.
