Individuals in the end-of-life (EOL) period may not be fully aware of their prognosis or know they are facing a terminal illness. As Asian beliefs and cultural tendencies intersect with Western values, health care practitioners may find their assumptions about disclosing an EOL prognosis differs from patients and their family members. Disagreements among family members regarding the disclosure of EOL to their terminally ill loved one can result in conflict—making difficult and sensitive times more burdensome. Little scientific evidence is known about first generation Asians who live in the United States (US) regarding their practices with disclosing EOL and how they handle conflict resolution when a family member is terminally ill. The purposes of this descriptive qualitative study were to explore issues surrounding patient awareness of dying and explore approaches to conflict resolution in EOL situations for first generation Japanese, Chinese and Vietnamese persons living in the south central, south eastern and northeastern parts of Texas. Face-to-face audio-recorded interviews were conducted and transcribed verbatim. Thematic analysis elicited three awareness and three conflict resolution overarching themes across all ethnic groups. Health care practitioners must be cognizant that assumed acculturation does not always coincide with Western beliefs regarding disclosure of the prognosis at the EOL. In order to provide culturally and ethically sound EOL care for the patient and their loved ones, clinicians must be mindful of the need to sensitively assess their patient’s beliefs and understand the importance of compassionate and diplomatic approaches for conflict resolution in Asian cultures.


End of Life, Truth Telling, Disclosure, Conflict Resolution, Asian

Author Bio(s)

Gloria Duke has been a nurse educator and researcher for over 30 years and has been passionate about helping persons and their loved ones to experience peaceful deaths with dignity. Previous research has included advance care planning, pain management, and cultural perspectives of end of life care. Her current research is focused on religious/spiritual perspectives of EOL care, specifically in the Jewish faith. Correspondence regarding this article can be addressed directly to: gduke@uttyler.edu.

Charlotte Wool, PhD, RN, is an Associate Professor of Nursing at York College of Pennsylvania. Correspondence regarding this article can also be addressed directly to: cwool1985@gmail.com.

Lobsang Tenzing, RN, BSN, works as a registered nurse at the North Central Surgical Center Hospital in Dallas, Texas. Correspondence regarding this article can also be addressed directly to: lobsangtenzing92@gmail.com.


We thank the American Nurses Foundation and The University of Texas at Tyler for funding this study. Special appreciation is owed to Dr. Cheryl Beck who conducted an audit trail of this study.

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