End-of-life care can be defined as the planning and supportive care that an individual receives at the end of his/her life (Huffman & Harmer, 2022). This care is traditionally multidimensional, embracing many aspects of well-being such as physical and psychological aspects, but also social, spiritual, environmental, and cultural factors (Fukuzawa & Kondo, 2017).

In general, individuals closer to the end-of-life tend to experience a complex and changing combination of emotions and thoughts, embracing different perspectives toward their death, and undergoing a series of subprocesses (i.e., psychological death, social death), which may coincide with the moment of biological death, or may precede it by days, weeks, or even months (Espinar Cid, 2012). During these transitions, each person draws on resources, both internal and external, to cope with fear, anguish, and sadness. (Ahmadi et al., 2019).

At the end of life, some of the greatest concerns of patients are to control pain symptoms, to reduce physical and emotional suffering, to avoid unnecessary prolongation of life, to feel fulfilled and reduce family burden, and to receive dignified and respectful treatment by the health professionals (Donnelly et al., 2018; Steinhauser et al., 2000). Although health professionals, especially nurses, strive to understand the preferences and priorities of their patients at the end of life, they consider communication and educational gaps as some of the most important barriers to provide such care (Price et al., 2017), especially for culturally diverse societies, such as Europe and North America (Hebert et al., 2011; International Organization for Migration, IOM, 2019). In this context, considering the cultural aspects of these individuals is an important objective of care.

Based on the previous literature, culture may have an important influence in end-of-life care. Focusing on patients' and families' perspectives, one systematic review evidenced that the conservation of cultural identity of origin, the value given to the family over the individual, the limited experience of migrants when accessing the health system of the host country, as well as language differences, constituted barriers among the Chinese immigrant community to receiving end-of-life care in high-income countries (Kwok et al., 2020). Following that same direction, Wicher and Meeker (2012) compared end-of-life preferences between African Americans and non-Hispanic White individuals, finding that African Americans used more aggressive life support therapies and less Advance Care Planning (ACP) documents, or hospice services. Religious beliefs also impact the visions and perspectives of end-of-life care as noted by Choudry et al. (2018) who observed different concepts of life, life after death, and the different rituals involved, among five religious' traditions in the UK.

Switching the focus to healthcare professionals, another review, carried out by Pentaris and Thomsen (2020), found that palliative care staff in Denmark and the UK felt the need to adapt their styles of care when working in multicultural contexts. Similarly, a review that studied culturally sensitive communication, found that communication barriers and cultural and personal factors were the two major influences found in 8 of the 9 studies included (Brooks et al., 2019).

Although there are studies assessing cultural elements in end-of-life care, they tend to focus on very specific aspects of this field, such as including a specific geographical region (Kwok et al., 2020; Pentaris & Thomsen, 2020; Wicher & Meeker, 2012), a single cultural element (Choudry et al., 2018), a certain disease (e.g., cancer) (Balante et al., 2021), a particular setting (e.g., intensive care units) (Wong et al., 2018), or embracing only a single aspect of care (Brooks et al., 2019).

Therefore, a broader review is needed in the current scientific literature, expanding the scope of interest, including different settings, samples, and cultural perspectives studied all over the world. This could help healthcare professionals to understand how important cultural aspects are to their patients, allowing them to provide integrated, humanized, and holistic care at the end of life.

Therefore, our research questions were: How do cultural aspects influence the needs, perceptions, and experiences of patients and their families in end-of-life care? What implications does cultural diversity have for professionals who care for individuals at the end of life? Therefore, the present study aims to investigate how cultural factors influence the provision of end-of-life care.