Dear Editor,

Flores et al. (Reference Flores, Heller and Dinicu2026) provide an important contribution to understanding end-of-life repatriation among Latinx immigrants. Their findings suggest that returning to the country of origin may support a favorable quality of death, with most caregivers reporting that patients were happy with the decision to return and that repatriation enhanced quality of life at the end of life. Their emphasis on early, culturally sensitive goals-of-care conversations is particularly valuable given documented disparities in the location and quality of end-of-life care among immigrant patients (Tergas et al. Reference Tergas, Prigerson and Shen2022a).

The authors’ recognition of familism and family-centered decision-making is also important. Family relationships, cultural values, spirituality, and communication can substantially shape palliative and end-of-life care experiences among Latino patients and their families (Smith et al. Reference Smith, Sudore and Pérez-stable2009). We propose one further consideration: cultural congruence may depend not only on recognizing patients’ cultural values, but also on how differences among patients, caregivers, and healthcare professionals are navigated. Flores et al. (Reference Flores, Heller and Dinicu2026) acknowledge the possibility of discordance between patients’ and caregivers’ end-of-life wishes. Although all patients in the study expressed a desire to return to their country of origin, repatriation may involve different concerns regarding safety, caregiving capacity, medical feasibility, family expectations, and emotional readiness.

A transformative conflict resolution perspective may complement the authors’ culturally sensitive approach. Bush and Folger (Reference Bush and Folger1994) conceptualize transformative mediation around 2 central processes: empowerment, or strengthening individuals’ capacity to make choices and express their perspectives, and recognition, or developing greater responsiveness to the perspectives and experiences of others. Applied to end-of-life care, this perspective shifts attention from simply reaching agreement about repatriation toward creating a relational process in which patients and caregivers can articulate and understand what the decision means to one another.

This perspective also highlights a potential role for counseling-informed support. Rather than directing medical decisions, counselors may facilitate value clarification, emotional expression, perspective-taking, and constructive communication among patients and families. Such processes may be particularly important when geographic preferences for dying are closely connected to identity, belonging, family relationships, and dignity. The therapeutic alliance and early communication emphasized by Flores et al. (Reference Flores, Heller and Dinicu2026) provide a natural foundation for this approach, particularly given evidence of disparities in therapeutic alliance among Latino immigrants with advanced cancer (Tergas et al. Reference Tergas, Prigerson and Shen2022b).

Therefore, goals-of-care conversations for immigrant patients might move beyond cultural sensitivity toward transformative, relationship-centered conversations. Integrating empowerment, recognition, and counseling-informed communication could help ensure that repatriation decisions are not only culturally congruent, but also respectful of the relationships through which end-of-life values are negotiated.