While Australian researchers have emphasized the language problems [38], Americans often explain cultural differences in terms of ethnicity [39], Asian studies stress the voice of the families thus

overlooking the autonomy of the patient [40,41], and Europeans explore the influence of religion [42,43]. Indeed, many Turkish and Moroccan patients and family Inhibitors,research,lifescience,medical members in our study indicated that their views were related to Islam, while their Dutch care providers thought that faith, in the broadest sense, was responsible for not accepting the ‘modern’ vision of communication and care in the final phase of life. The assumption that views on palliative care are influenced Inhibitors,research,lifescience,medical by religious background is confirmed by studies showing that African immigrants in the US and England refer to their Christian beliefs if they resist advanced care planning and an open discussion on diagnosis and prognosis. They prefer extending life with all possible measures and rely on the family as surrogate Inhibitors,research,lifescience,medical decision makers [44-47]. However, studies comparing religious doctrines and directives on end-of life decisions for Christians, Muslims and other believers reveal that instructions from holy books and religious legislative bodies on issues like curative care

up to the end-of-life and dying with a clear mind, still allow for a variety of interpretations [48]. The open Inhibitors,research,lifescience,medical and direct manner of communication of care providers in this study is also related to the Dutch system of health care, which provides everyone with a GP [49]. The care providers are used to the liberal Dutch society where self-determination and consensus are highly valued [50-52]. Dutch care providers Inhibitors,research,lifescience,medical are, in general, proud of these ‘achievements’. However, perceptions on end-of-life decisions and actual medical practices vary across multicultural Europe [53,54,43]. We would recommend that care providers place their own perceptions and practices in perspective, and consider the religious and cultural views of their patients and family members [49,55]. Care providers

have to keep in mind that their own views on open communication of an infaust diagnosis and prognosis may not be the norm for why everybody. A limitation of our study is that professionals, patients and relatives who are dissatisfied with the care provided and mutual communication were probably less inclined to participate in our study and therefore are GSK1363089 price underrepresented. But we suspect that people in these target groups who are less motivated or less satisfied would have had similar or even worse communication and decision making problems than our respondents. We believe our presented findings are applicable to other Turkish and Moroccan immigrants and their care providers in the Netherlands.