Challenges in the Provision of End-of-life and Palliative Care to Ethnic Nepali Refugees.

After over a decade of resettlement of ethnic Nepali refugees in the United States, a significant population of seriously ill refugees will require palliative care and hospice care. The refugee experience and culturally specific factors affect the end-of-life care of this population. Challenges in the end-of-life care of Nepali refugees include challenges related to social and health inequities such as significant chronic respiratory disease burden, lack of protocols for deferral of illness disclosure, lack of support for group decision making, unfamiliarity with spiritual, religious and traditional health practices and difficulty with cross cultural communication. Culturally competent care of ethnic Nepali refugees can be accomplished through respectful exploration of patients' and families' preferences regarding the challenges identified. This article presents recommendations which can guide primary and specialist palliative care for this population.