{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:53:17Z","timestamp":1782489197356,"version":"3.54.5"},"reference-count":66,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,21]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To synthesise existing qualitative and conceptual literature on the implementation, ethical considerations and policy implications of Medical Assistance in Dying for Mental Disorder as a Sole Underlying Medical Condition (MAiD MD-SUMC) in Canada and internationally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A qualitative evidence synthesis using a thematic analysis approach. Empirical, conceptual and policy papers addressing MAiD for mental disorders were identified through major databases and grey literature. Studies were thematically analysed to identify recurring ethical, clinical and policy themes related to eligibility, assessment and implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Data was extracted from a systematic search of Medline and Embase for peer-reviewed studies published from 1974 onwards, supplemented by relevant policy documents and legal cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Studies were included if they examined MAiD MD-SUMC and explored ethical, legal or clinical considerations or provided stakeholder perspectives. Exclusion criteria included studies focusing solely on non-psychiatric conditions or not published in English.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Two independent reviewers screened, extracted and analysed data using an iterative thematic synthesis approach. Key themes were identified through consensus discussions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The synthesis identified four major themes: (1) Irremediability and treatment resistance\u2014persistent uncertainty regarding when mental disorders can be considered irremediable. (2) Capacity and vulnerability\u2014ongoing debate about assessing capacity amid fluctuating symptoms and social influences. (3) Ethical and policy considerations\u2014divergent interpretations of autonomy, justice and safeguards highlighting the need for standardised criteria. (4) Public and professional perspectives\u2014public and family support for inclusion, although clinician hesitancy exists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The evidence supports a thoughtful, structured approach to potential implementation of MAiD MD-SUMC in Canada. Future priorities include refining criteria for irremediability, standardising capacity assessments, addressing disorder-specific complexities and strengthening mental health infrastructure. Continued research, engagement and transparent policy dialogue will be essential to ensure that any expansion of MAiD upholds ethical integrity, protects vulnerable persons and maintains public trust.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105129","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T16:00:17Z","timestamp":1777910417000},"page":"e105129","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7026-6881","authenticated-orcid":false,"given":"Alicia","family":"Pawluk","sequence":"first","affiliation":[{"name":"The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Arksey","sequence":"additional","affiliation":[{"name":"The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary","family":"Jansens","sequence":"additional","affiliation":[{"name":"The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijia","family":"Qiao","sequence":"additional","affiliation":[{"name":"The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"McFarlane","sequence":"additional","affiliation":[{"name":"The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"2026062608310439000_16.5.e105129.1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"2026062608310439000_16.5.e105129.2","unstructured":"Health Canada . Final Report of the Expert Panel on MAiD and Mental Illness, Canada. 2022. Available: https:\/\/www.canada.ca\/en\/health-canada\/corporate\/about-health-canada\/public-engagement\/external-advisory-bodies\/expert-panel-maid-mental-illness\/final-report-expert-panel-maid-mental-illness.html"},{"key":"2026062608310439000_16.5.e105129.3","unstructured":"World Health Organization . ICD-11: International classification of diseases (11th revision), 2022. Available: https:\/\/icd.who.int\/"},{"key":"2026062608310439000_16.5.e105129.4","unstructured":"Federal Public Service (FPS) Health Belgium . Federal Commission for the Control and Evaluation of Euthanasia, 2026. Available: https:\/\/consultativebodies.health.belgium.be\/en\/advisory-and-consultative-bodies\/federal-commission-control-and-evaluation-euthanasia"},{"key":"2026062608310439000_16.5.e105129.5","unstructured":"Government of Netherlands . Is Euthanasia Allowed in the Netherlands?, 2026. Available: https:\/\/www.government.nl\/topics\/euthanasia\/is-euthanasia-allowed"},{"key":"2026062608310439000_16.5.e105129.6","unstructured":"The Government of the Grand Duchy of Luxembourg . Information on Requesting Euthanasia or Assisted Suicide, 2026. Available: https:\/\/guichet.public.lu\/en\/citoyens\/sante\/fin-vie\/euthanasie\/euthanasie-assistance-suicide.html"},{"key":"2026062608310439000_16.5.e105129.7","doi-asserted-by":"publisher","DOI":"10.2143\/EP.9.2.503856"},{"key":"2026062608310439000_16.5.e105129.8","doi-asserted-by":"publisher","DOI":"10.1093\/jmp\/jhaa031"},{"key":"2026062608310439000_16.5.e105129.9","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.210929"},{"key":"2026062608310439000_16.5.e105129.10","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s11920-022-01339-y","article-title":"Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders","volume":"24","author":"Grassi","year":"2022","journal-title":"Curr Psychiatry Rep"},{"key":"2026062608310439000_16.5.e105129.11","unstructured":"Rodriguez V . British Columbia (Attorney General), 1993. Available: https:\/\/decisions.scc-csc.ca\/scc-csc\/scc-csc\/en\/item\/1054\/index.do"},{"key":"2026062608310439000_16.5.e105129.12","unstructured":"Supreme Court Judgments . Carter v. Canada (Attorney General), 2015. Available: https:\/\/decisions.scc-csc.ca\/scc-csc\/scc-csc\/en\/item\/14637\/index.do"},{"key":"2026062608310439000_16.5.e105129.13","unstructured":"Gouvernement de Quebec . Act respecting end-of-life care, 2024. Available: https:\/\/www.legisquebec.gouv.qc.ca\/en\/document\/cs\/s-32.0001"},{"key":"2026062608310439000_16.5.e105129.14","unstructured":"Government of Canada, Department of Justice, Electronic Communications . Part 1 - Description of Proposed Legislation on Medical Assistance in Dying - Legislative Background: Medical Assistance in Dying (Bill C-14), 2016. Available: https:\/\/www.justice.gc.ca\/eng\/rp-pr\/other-autre\/ad-am\/p2.html"},{"key":"2026062608310439000_16.5.e105129.15","unstructured":"Canada (Attorney General) v. EF. ABCA 155. 2016."},{"key":"2026062608310439000_16.5.e105129.16","unstructured":"Truchon V . Procureur g\u00e9n\u00e9ral du Canada (AG). 2019."},{"key":"2026062608310439000_16.5.e105129.17","unstructured":"An Act to amend the Criminal Code (medical assistance in dying), 2021. Available: https:\/\/laws-lois.justice.gc.ca\/eng\/AnnualStatutes\/2021_2\/page-1.html"},{"key":"2026062608310439000_16.5.e105129.18","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1176\/ps.49.11.1475","article-title":"Physician-assisted suicide in psychiatry: developments in The Netherlands","volume":"49","author":"Schoevers","year":"1998","journal-title":"Psychiatr Serv"},{"key":"2026062608310439000_16.5.e105129.19","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-12-181","article-title":"Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ","volume":"12","author":"Tong","year":"2012","journal-title":"BMC Med Res Methodol"},{"key":"2026062608310439000_16.5.e105129.20","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.5.513"},{"key":"2026062608310439000_16.5.e105129.21","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1038\/s41386-023-01689-y","article-title":"Intravenous ketamine for benzodiazepine deprescription and withdrawal management in treatment-resistant depression: a preliminary report","volume":"48","author":"Garel","year":"2023","journal-title":"Neuropsychopharmacology"},{"key":"2026062608310439000_16.5.e105129.22","doi-asserted-by":"publisher","DOI":"10.1007\/s11673-016-9759-4"},{"key":"2026062608310439000_16.5.e105129.23","first-page":"374","article-title":"Patient autonomy and the defence of medical necessity: five Dutch euthanasia cases","volume":"34","author":"Sneiderman","year":"1996","journal-title":"Alta Law Rev"},{"key":"2026062608310439000_16.5.e105129.24","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1080\/07481187.2022.2042754","article-title":"Are unmet needs driving requests for Medical Assistance in Dying (MAiD)? A qualitative study of Canadian MAiD providers","volume":"47","author":"Wiebe","year":"2023","journal-title":"Death Stud"},{"key":"2026062608310439000_16.5.e105129.25","unstructured":"Sixth Annual Report on Medical Assistance in Dying in Canada, Available: https:\/\/www.canada.ca\/en\/health-canada\/services\/publications\/health-system-services\/annual-report-medical-assistance-dying-2024.html"},{"key":"2026062608310439000_16.5.e105129.26","doi-asserted-by":"publisher","DOI":"10.1007\/s10728-017-0344-8"},{"key":"2026062608310439000_16.5.e105129.27","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1017\/S0033291719000333","article-title":"Euthanasia and assisted suicide of persons with psychiatric disorders: the challenge of personality disorders","volume":"50","author":"Nicolini","year":"2020","journal-title":"Psychol Med"},{"key":"2026062608310439000_16.5.e105129.28","unstructured":"Canadian Association For Suicide Prevention . CASP Issues Statement about MAiD for Mental Illness, 2022. Available: https:\/\/suicideprevention.ca\/media\/casp-issues-statement-about-maid-for-mental-illness\/"},{"key":"2026062608310439000_16.5.e105129.29","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2021-107493"},{"key":"2026062608310439000_16.5.e105129.30","doi-asserted-by":"crossref","first-page":"116075","DOI":"10.1016\/j.socscimed.2023.116075","article-title":"Searching for relief from suffering: A patient-oriented qualitative study on medical assistance in dying for mental illness as the sole underlying medical condition","volume":"331","author":"Bastidas-Bilbao","year":"2023","journal-title":"Soc Sci Med"},{"key":"2026062608310439000_16.5.e105129.31","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1080\/02813432.2021.1913895","article-title":"Experiences and views of Dutch general practitioners regarding physician-assisted death for patients suffering from severe mental illness: a mixed methods approach","volume":"39","author":"Pronk","year":"2021","journal-title":"Scand J Prim Health Care"},{"key":"2026062608310439000_16.5.e105129.32","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jagp.2017.09.018","article-title":"End-of-Life Care Preferences in Patients with Severe and Persistent Mental Illness and Chronic Medical Conditions: A Comparative Cross-Sectional Study","volume":"26","author":"Elie","year":"2018","journal-title":"Am J Geriatr Psychiatry"},{"key":"2026062608310439000_16.5.e105129.33","first-page":"070674372092307","article-title":"Irremediable Psychiatric Suffering in the Context of Physician-assisted Death: A Scoping Review of Arguments","volume":"65","author":"Veen","year":"2020","journal-title":"Canadian J Psych"},{"key":"2026062608310439000_16.5.e105129.34","doi-asserted-by":"crossref","DOI":"10.1136\/bmjment-2023-300729","article-title":"Patients requesting and receiving euthanasia for psychiatric disorders in the Netherlands","volume":"26","author":"Kammeraat","year":"2023","journal-title":"BMJ Mental Health"},{"key":"2026062608310439000_16.5.e105129.35","doi-asserted-by":"publisher","DOI":"10.1177\/0706743718766055"},{"key":"2026062608310439000_16.5.e105129.36","unstructured":"Vulnerable Persons Standard, Available: https:\/\/www.vps-npv.ca\/read-the-standard-20"},{"key":"2026062608310439000_16.5.e105129.37","doi-asserted-by":"publisher","DOI":"10.1136\/jme-2022-108431"},{"key":"2026062608310439000_16.5.e105129.38","unstructured":"Battin MP . The least worst death: essays on bioethics at the end of life. New York, 1994."},{"key":"2026062608310439000_16.5.e105129.39","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s10730-022-09472-0","article-title":"A Sceptics Report: Canada\u2019s Five Years Experience with Medical Termination (MAiD)","volume":"35","author":"Koch","year":"2023","journal-title":"HEC Forum"},{"key":"2026062608310439000_16.5.e105129.40","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-017-1369-0","article-title":"Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases","volume":"17","author":"Dierickx","year":"2017","journal-title":"BMC Psychiatry"},{"key":"2026062608310439000_16.5.e105129.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2020.12.006"},{"key":"2026062608310439000_16.5.e105129.42","doi-asserted-by":"crossref","DOI":"10.1503\/cmaj.732886","article-title":"The slippery slope argument and medical assistance in dying","volume":"189","author":"Reggler","year":"2017","journal-title":"CMAJ"},{"key":"2026062608310439000_16.5.e105129.43","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-019-2053-3","article-title":"Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists","volume":"19","author":"Evenblij","year":"2019","journal-title":"BMC Psychiatry"},{"key":"2026062608310439000_16.5.e105129.44","doi-asserted-by":"publisher","DOI":"10.1017\/S0963180100006721"},{"key":"2026062608310439000_16.5.e105129.45","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-019-1325-6","article-title":"In-hospital care prior to assisted and unassisted suicide in swiss older people: a state-level retrospective study","volume":"19","author":"Dieudonn\u00e9-Rahm","year":"2019","journal-title":"BMC Geriatr"},{"key":"2026062608310439000_16.5.e105129.46","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2020-107133"},{"key":"2026062608310439000_16.5.e105129.47","doi-asserted-by":"crossref","first-page":"28","DOI":"10.12927\/hcpol.2019.26073","article-title":"Medical Assistance in Dying (MAiD) in Canada: A Critical Analysis of the Exclusion of Vulnerable Populations","volume":"15","author":"Konder","year":"2019","journal-title":"hcpol"},{"key":"2026062608310439000_16.5.e105129.48","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jpainsymman.2020.02.016","article-title":"Suicide Attempt After Determination of Ineligibility for Assisted Death: A Case Series","volume":"60","author":"Isenberg-Grzeda","year":"2020","journal-title":"J Pain Symptom Manage"},{"key":"2026062608310439000_16.5.e105129.49","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1016\/j.healthpol.2021.05.004","article-title":"Wish for euthanasia persists for at least one year after the request was declined by Euthanasia Expertise Center","volume":"125","author":"van den Ende","year":"2021","journal-title":"Health Policy"},{"key":"2026062608310439000_16.5.e105129.50","doi-asserted-by":"crossref","unstructured":"Vargo A . Death with Dignity in Canada. VIB 2022;8. doi:10.52214\/vib.v8i.9473","DOI":"10.52214\/vib.v8i.9473"},{"key":"2026062608310439000_16.5.e105129.51","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s12910-019-0404-8","article-title":"Public and physicians\u2019 support for euthanasia in people suffering from psychiatric disorders: a cross-sectional survey study","volume":"20","author":"Evenblij","year":"2019","journal-title":"BMC Med Ethics"},{"key":"2026062608310439000_16.5.e105129.52","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.jagp.2020.07.013","article-title":"Assessing Public\u2019s Attitudes Towards Euthanasia and Assisted Suicide of Persons With Dementia Based on Their Advance Request: An Experimental Survey of US Public","volume":"29","author":"Mangino","year":"2021","journal-title":"Am J Geriatr Psych"},{"key":"2026062608310439000_16.5.e105129.53","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1177\/08258597211050738","article-title":"Canadian Undergraduates\u2019 Perspectives on Medical Assistance in Dying (MAiD): A Quantitative Study","volume":"37","author":"Hawrelak","year":"2022","journal-title":"J Palliat Care"},{"key":"2026062608310439000_16.5.e105129.54","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1177\/10499091241247835","article-title":"Canadian Undergraduate Perspectives on Medical Assistance in Dying for Mental Illness: Does Psychiatric Illness Type, Age, and Exposure to Information Influence Acceptance of MAiD?","volume":"42","author":"Harper","year":"2025","journal-title":"Am J Hosp Palliat Care"},{"key":"2026062608310439000_16.5.e105129.55","unstructured":"Dying with Dignity Canada . Support for medically-assisted dying in Canada, 2023. Available: https:\/\/www.dyingwithdignity.ca\/wp-content\/uploads\/2023\/03\/DWDCanada-Final-Report_June-30-2023.pdf"},{"key":"2026062608310439000_16.5.e105129.56","first-page":"314","article-title":"Medical Assistance in Dying for Mental Illness as a Sole Underlying Medical Condition and Its Relationship to Suicide: A Qualitative Lived Experience-Engaged Study","volume":"69","author":"Hawke","year":"2023","journal-title":"Canad J Psych"},{"key":"2026062608310439000_16.5.e105129.57","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1024\/1662-9647\/a000248","article-title":"Acceptability of Assisted Suicide in Patients With Severe and Persistent Mental Illness","volume":"34","author":"Gloeckler","year":"2021","journal-title":"GeroPsych (Bern)"},{"key":"2026062608310439000_16.5.e105129.58","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1007\/s11013-020-09686-2","article-title":"Do Doctors Differentiate Between Suicide and Physician-Assisted Death? A Qualitative Study into the Views of Psychiatrists and General Practitioners","volume":"45","author":"Pronk","year":"2021","journal-title":"Cult Med Psychiatry"},{"key":"2026062608310439000_16.5.e105129.59","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2014-102458"},{"key":"2026062608310439000_16.5.e105129.60","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1001\/jamapsychiatry.2015.2887","article-title":"Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014","volume":"73","author":"Kim","year":"2016","journal-title":"JAMA Psychiatry"},{"key":"2026062608310439000_16.5.e105129.61","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291722002951"},{"key":"2026062608310439000_16.5.e105129.62","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2022.909194","article-title":"Practical Issues of Medical Experts in Assessing Persons With Mental Illness Asking for Assisted Dying in Switzerland","volume":"13","author":"Hachtel","year":"2022","journal-title":"Front Psychiatry"},{"key":"2026062608310439000_16.5.e105129.63","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1001\/jamapsychiatry.2014.185","article-title":"Requests for Euthanasia\/Physician-Assisted Suicide on the Basis of Mental Suffering","volume":"71","author":"Deschepper","year":"2014","journal-title":"JAMA Psychiatry"},{"key":"2026062608310439000_16.5.e105129.64","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1037\/h0086867","article-title":"The role of the psychologist in determining competence for assisted suicide\/euthanasia in the terminally ill","volume":"41","author":"Galbraith","year":"2000","journal-title":"Can Psychol"},{"key":"2026062608310439000_16.5.e105129.65","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-024-05541-5","article-title":"Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives","volume":"24","author":"Stergiopoulos","year":"2024","journal-title":"BMC Psychiatry"},{"key":"2026062608310439000_16.5.e105129.66","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.162.11.1257"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-105129","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:38:41Z","timestamp":1782488321000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-105129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":66,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,4]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bmjopen-2025-105129"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-105129","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}