Breaking the Silence: Intercultural Palliative Care, Cultural Secrecy, and End of Life Communication in Nso Cultural Experience

Abstract Palliative care is not only a clinical task. It is also a communicative, relational, psychological, social, and spiritual process. How a person and a family understand diagnosis, prognosis, suffering, disclosure, autonomy, and dying is shaped partly by cultural experience. This reflective conceptual paper examines end-of-life communication through the specific lens of Nso cultural experience in Cameroon. It was prompted by the author's personal experience of losing a cousin and a close friend to cancer, where the diagnoses were kept secret within limited family circles. These experiences are treated as reflexive starting points rather than as evidence of prevalence or universal Nso practice. Building on the author's presentation on intercultural palliative medicine in Berlin on 28 October 2024, delivered within a continuing-education event recognized by the Ärztekammer Berlin, and on his professional practice as a systemic psychological coach and certified German mediator, the paper examines how protective secrecy can emerge within relational and culturally embedded systems. Edward T. Hall's contexting framework, Eric Berne's Transactional Analysis, and Friedemann Schulz von Thun's Four-Ears Model are integrated with contemporary literature on culturally diverse palliative care, communication, and African palliative-care needs. The paper proposes a practical concept, culturally translated transparency, which seeks to preserve relational and cultural dignity while protecting patient participation, informed decision-making, and access to appropriate palliative support. The argument is not that direct disclosure is inherently Western or that secrecy is inherently Nso. Rather, intercultural competence requires clinicians and families to establish what the individual patient wants to know, who should be involved, how information should be communicated, and how cultural, spiritual, and family meanings can be integrated without unnecessarily excluding the patient. The paper concludes with a six-step communication model and a research agenda for future Nso-specific empirical work. Keywords: palliative care; intercultural communication; Nso; Cameroon; illness disclosure; high-context communication; systemic coaching; conflict mediation; end-of-life communication; family-centered care; cultural humility