Foreign studies on caregivers' use of QPL in end-of-life care, decision-making, and satisfaction are mostly conducted with family members who share the same language. Foreign family caregivers are a local cultural feature of Taiwan. This study explores the role of foreign family caregivers in end-of-life care in Taiwan. Cultural issues and differences, whether the number of questions asked, care readiness and self-efficacy can be increased after the intervention of the end-of-life care QPL, and the use of QPL that is appropriate for Indonesian culture to communicate and prepare for end-of-life care in hospice home care, is expected to provide A reference for communication between medical teams and foreign home caregivers and improvement of care quality.

Research Background and Purpose Since Taiwan allowed the employment of foreign family caregivers in 1992, the proportion of caregiving roles taken up by these workers has steadily increased. However, many foreign family caregivers lack the cognitive and social skills needed for end-of-life care. When faced with challenges, they often resort to sending patients back to the hospital, resulting in higher medical costs. These caregivers frequently do not know what to expect or how to ask relevant questions, underscoring the need for clear information to assist them in communicating with healthcare teams. The Question Prompt List (QPL) is a simple, personalized, and cost-effective tool that helps individuals structure their thoughts, ask questions, gain a sense of control, gather information, and facilitate communication between caregivers and healthcare providers.

Although there has been increasing domestic research on the caregiving abilities and stress of foreign caregivers, studies on communication tools for end-of-life care are limited. Internationally, research on the use of QPLs in end-of-life caregiving often focuses on family members sharing a common language, but Taiwan's reliance on foreign caregivers presents unique cultural characteristics. This study explores the challenges and cultural differences experienced by foreign caregivers in Taiwan's end-of-life care setting. It examines whether using a culturally appropriate QPL tailored to Indonesian caregivers can enhance the number and quality of questions raised during communication and improve the overall effectiveness of communication. The findings are expected to provide valuable insights for improving communication and care quality between healthcare teams and foreign caregivers. Research Method V This study adopts a two-group randomized experimental design supplemented by qualitative data analysis to evaluate the effectiveness of a QPL in end-of-life care. The participants are Indonesian caregivers working in hospice wards or providing home care at a medical center in eastern Taiwan. The experimental group received QPL intervention as part of end-of-life care education and communication, while the control group received standard education and communication guidance. The outcome measures include self-designed questionnaires assessing communication self-efficacy, caregiving preparedness, and communication satisfaction. Paired t-tests and ANCOVA were used to analyze differences between pretest and posttest results within and between groups. Qualitative data were collected through feedback records during the communication guidance process and semi- structured interviews to gather participants' experiences and perceptions of using the QPL.

Inclusion Criteria:

1. Those who are fluent in Mandarin or Indonesian and have no reading or hearing impairment;
2. Agree to accept the commission and the Taxation Committee issues a letter of approval for the legal Indonesian guardian

Exclusion Criteria:

1. Those who are unable to communicate in Mandarin or Indonesian;
2. The employer of the patient has changed jobs and the patient cannot be contacted after the patient passes away;
3. Those who are under great pressure of end-of-life care or are physically unfit to take the questionnaire

single-blind study