In China, talking about death is considered bad luck — which is why Sandy Chen Stokes, 56, struggles to even broach the subject with the families of terminally ill Chinese American patients.

"When children try to bring up subjects like health care directives, parents will say, 'Are you trying to make me die earlier?' " says Stokes, a geriatric nurse. But that avoidance creates an intense burden for families, who scramble for last-minute solutions. In 2005 Stokes founded the Chinese American Coalition for Compassionate Care (CACCC), which provides information and resources to families whose loved ones are ill. Initially the group worked to translate basic end-of-life directives into Chinese, recruiting volunteers to explain these forms to elderly Chinese Americans. Today CACCC works with more than 60 different health care organizations, including the American Cancer Society, to train health care workers about end-of-life issues for this population.

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