Journal of General Internal Medicine

, Volume 27, Issue 3, pp 311–317

Traditional Expectations Versus US Realities: First- and Second-Generation Asian Indian Perspectives on End-of-Life Care

  • Rashmi K. Sharma
  • Nidhi Khosla
  • James A. Tulsky
  • Joseph A. Carrese
Original Research

DOI: 10.1007/s11606-011-1890-7

Cite this article as:
Sharma, R.K., Khosla, N., Tulsky, J.A. et al. J GEN INTERN MED (2012) 27: 311. doi:10.1007/s11606-011-1890-7



Although end-of-life care preferences vary across racial/ethnic groups, little is known about how cultural values affect end-of-life care preferences among South Asian immigrants and their offspring in the US.


To examine the perspectives of first- and second-generation South Asians living in the US regarding end-of-life care.


Focus group study. Discussions explored participant preferences and experiences with family members facing the end of life.


Twelve first-generation and 11 second-generation self-identified Asian Indians living in the mid-Atlantic region.


Content analysis of focus group transcripts.


First-generation participants ranged in age from 41 to 76 years and were evenly split by gender. Second-generation participants ranged in age from 23 to 36 years and included seven women and four men. All participants were highly educated, and two thirds were either studying or working in a health care field. All but two subjects were Hindu. Several themes emerged that highlighted cultural differences and challenges for this population in the context of end-of-life care: attitudes toward death and suffering; family duty; and preferences for information disclosure and decision making. Participants described cultural challenges due to the evolution of traditional roles, lack of explicit discussion between patients and family members about preferences and care expectations, and a tension between wanting to meet traditional expectations and the challenges in doing so given US social realities.


Traditional cultural values, such as duty to family, greatly influenced end-of-life care preferences and retained importance across generations. Clinicians caring for Asian Indian patients at the end of life may be better able to assess care preferences after exploring the complex interplay between traditional expectations and specific social realities for each patient. Particular attention should be given to attitudes toward death and suffering, family duty, and preferences for information disclosure and decision making.


cultural differencesend-of-life careadvance directivesimmigrant healthqualitative research

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Rashmi K. Sharma
    • 1
  • Nidhi Khosla
    • 2
  • James A. Tulsky
    • 3
  • Joseph A. Carrese
    • 4
    • 5
  1. 1.Division of Hospital MedicineNorthwestern UniversityChicagoUSA
  2. 2.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Center for Palliative CareDuke University and Durham VA Medical CenterDurhamUSA
  4. 4.Division of General Internal Medicine, Department of MedicineJohns Hopkins School of MedicineBaltimoreUSA
  5. 5.Berman Institute of BioethicsJohns Hopkins UniversityBaltimoreUSA