Hospice and palliative care providers recognize the value of effective communication to facilitate exploration of patients' and families' values and goals; however, many providers struggle to perform these key tasks when patients cannot communicate in English or have cultural norms which differ significantly from their own. Concepts such as autonomy and patient self-determination, 'truth telling'/disclosure of difficult news, shared decision making, as well as the acceptability of various treatments and communication techniques may present invisible barriers for palliative care providers working across cultures.