Cross-cultural studies give the advantages of large sample size, multi-centered sites and heterogeneity; nevertheless, it poses several challenges as well. Take palliative medicine as an example, for the past years, Taiwan has actively formed research network with many countries and has been actively involved in international end-of-life research such as the EASED (East-Asian collaborative Study to Elucidate the Dying process) cohort I and II with Japan, Korea, ACP ( Advance Care Planning) Asian Delphi with six Asian countries and Heart Failure Delphi studies with US, Europe. We have extensively investigated on the topics of quality of dying and death, artificial hydration, communication, prognostication, advance care planning and non- cancer referral criteria in the hope to provide evidences or guidelines for clinical practice.  Throughout the networking, commitment, mutual trust and resilience are the key factors for success and sustainability. We have established a platform not only for research but also for education of future generations.