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Background: The end of life represents a therapeutic context that acutely raises cultural and linguistic specificities, yet there is very little evidence illustrating the importance of such dynamics in shaping choices, trajectories and care practices. Culture and language interplay to offer considerable potential challenges to both patient and provider, with further work needed to explore patient and caregiver perspectives across cultures and linguistic groups, and provider perspectives. The objective of this study was to develop a critical, evidence-based understanding of the experiences of people from Culturally and Linguistically Diverse (CALD) backgrounds, and their caregivers, in a palliative care setting., Methods: A qualitative study, using semi-structured interviews to explore key experiences and perspectives of CALD patients and caregivers currently undergoing treatment under oncology or palliative care specialists in two Australian hospitals. Interviews were digitally audio recorded and transcribed in full. A thematic analysis was conducted utilising the framework approach., Results: Sixteen patients and fourteen caregivers from a range of CALD backgrounds participated in semi-structured interviews. The research identified four prevalent themes among participants: (1) Terminology in the transition to palliative care; (2) Communication, culture and pain management; (3) (Not) Talking about death and dying; and, (4) Religious faith as a coping strategy: challenging the terminal diagnosis., Conclusions: CALD patients and caregivers' experiences are multifaceted, particularly in negotiating linguistic difficulties, beliefs about treatment, and issues related to death and dying. Greater attention is needed to develop effective communication skills, recognise CALD patients' particular cultural, linguistic and spiritual values and needs, and acknowledge the unique nature of each doctor-patient interaction.

Aim: Medical consultations focused on managing the transition to palliative care are interpersonally challenging and require high levels of communicative competence. In the context of non-English speaking patients, communication challenges are further complicated due to the requirement of interpreting; a process with the potential to add intense layers of complexity in the clinical encounter, such as misunderstanding, misrepresentation and power imbalances. The aim of the study was to explore the experiences and perspectives of professional interpreters in supporting the transition of culturally and linguistically diverse patients to specialist palliative care., Methods: Qualitative, semistructured interviews with 20 professional interpreters working in oncology and palliative care settings in two metropolitan hospitals in Queensland, Australia., Results: Four key themes emerged from the thematic analysis: the challenges of translating the meaning of "palliative care"; managing interpreting in the presence of family care-givers; communicating and expressing sensitivity while remaining professional and interpreters' own emotional burden of difficult clinic encounters between doctor and patient negotiations., Conclusion: The results suggest that interpreters face a range of often concealed interpersonal and interprofessional challenges and recognition of such dynamics will help provide necessary support for these key stakeholders in the transition to palliative care. Enriched understanding of interpreters' experiences has clinical implications on improving how health professionals interact and work with interpreters in this sensitive setting., (© 2016 John Wiley & Sons Australia, Ltd.)

There is an increasing emphasis on meeting the healthcare needs of culturally and linguistically diverse (CALD) communities in Australia. Negotiating the point of futility and the transition to specialist palliative care requires not only effective communication but also sensitivity to cultural and linguistic specificities. This can be a challenging process for clinicians, patients and families. Here, we outline some of the key challenges currently facing many clinicians in the context of CALD patients, with particular reference to the transitioning of patients to specialist palliative care. We suggest a focus on further research that can systematically document and model existing CALD-specific clinical processes and pathways, which can then support the development of targeted educational interventions. This includes developing a multi-stakeholder understanding of the CALD experience that moves beyond cultural stereotyping and predicting need., (© 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.)