cultural groups, developed countries, end-of-life care, preferences, review literature



  1. Thomas, Roger MD, PhD, CCFP, MRCGP
  2. Wilson, Donna M. PhD, RN
  3. Justice, Christopher PhD
  4. Birch, Stephen DPhil
  5. Sheps, Sam MD, MSc


Anticipatory decision making about end-of-life care is predominantly a North American concept. Researchers investigated four themes: advance directives, life support, communication, and decision making. Substantial differences exist among cultural groups in the percentages with living wills/advance directives, and they are less frequent for those with family-centered decision making or with less trust in the healthcare system. African Americans prefer life support more than Asian Americans or European Americans. Cultural groups vary in their preferences about communicating terminal diagnoses. Non-English-speaking patients perceive communication as a barrier to care. Mexican Americans, Korean Americans, and Canadian First Nations emphasize family-based decision making at the end of life, and European Americans emphasize patient autonomy.