We congratulate Lindell and colleagues1 on their recent article in CHEST (February 2015) on palliative care and location of death in idiopathic pulmonary fibrosis (IPF). Despite advances in treatments that slow disease progression, IPF remains a fatal disease. Radical treatment (ie, to alter the natural history) and palliative therapies often coincide, creating uncertainties as to the timing of palliative care referral, to best meet the needs of the patient, family, and care providers.2,3 Lindell and colleagues1 show that referral to palliative care occurred in a minority of patients and only late in the disease. They also showed that the majority of patients with IPF died in the hospital (57%), with 33% dying in the ICU.1,4 The remaining 43% of patients died in a hospice. These findings are discordant with our combined experience, causing us to speculate that cultural factors might be a highly influential determinant of communication about palliation and place of dying.