**3.3 Impact of care giver preferences on prognostic communication**

While important on an individual level, cultural and community factors often guide care giver communication preferences. For instance, South American and Asian cultures are less likely to believe patients should be told about a terminal prognosis [29]. This discrepancy between patient and family preferences can contribute to prognostic communication barriers. Discussing prognosis often involves a family member as the patient may rely increasingly on a family member for decision making and care—and the patient, especially if elderly, is often more receptive than the family when hearing prognostic information.
