{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:57:44Z","timestamp":1781873864956,"version":"3.54.5"},"reference-count":40,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"schoberstiftung \u2013 Stiftung f\u00fcr christliche Hospizarbeit"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,29]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Muslim immigrants and their direct descendants are a large ethnoreligious minority in many regions, yet their access to palliative care remains under-researched and poorly theorised for practice. Existing evidence points to structural, communicative and cultural constraints, while mechanisms at the threshold of access remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>We explored access to palliative care among this population, developed an explanatory model of access dynamics and reconstructed culturally and religiously framed narrative resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We conducted a qualitative, multicentre, four-group study using constructivist Grounded theory with complementary Narrative inquiry. Loosely structured interviews followed Kaufmann\u2019s \u2018L\u2019entretien compr\u00e9hensif\u2019 between August 2021 and December 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/participants<\/jats:title>\n                    <jats:p>This study involved six centres in North Rhine-Westphalia, Germany. Participants were 53 adults from 14 countries in four groups (patients receiving palliative care vs not, relatives, interface stakeholders).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The Grounded theory\n                      <jats:italic>SAME SAME BUT DIFFERENT<\/jats:italic>\n                      conceptualises a paradox between formal equality and lived constraint at the threshold of access. Six analytical categories operated cyclically and mutually reinforced delayed access: (I)\n                      <jats:italic>Othering\/Belonging<\/jats:italic>\n                      , (II)\n                      <jats:italic>Information\/Representation<\/jats:italic>\n                      , (III)\n                      <jats:italic>Role of the family<\/jats:italic>\n                      , (IV)\n                      <jats:italic>Palliative stigma<\/jats:italic>\n                      , (V)\n                      <jats:italic>\u2018Language barrier\u2019 as a multidimensional challenge<\/jats:italic>\n                      and (VI)\n                      <jats:italic>Dealing with life crisis, illness and death<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>Participants identified leverage points within the access dynamics, including native-language information and contact persons, openness to cultural-religious concerns, culture- and religion-sensitive training, Muslim support services and spiritual care and non-denominational environments.<\/jats:p>\n                    <jats:p>Narrative inquiry reconstructed four culturally and religiously framed narrative resources that shaped access decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intersecting structural, communicative and meaning-making dynamics affect access to palliative care. Culturally adaptive, multilingual and community-engaged approaches require evaluation and should be supported by improved routine sociodemographic data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119027","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:45:57Z","timestamp":1781873157000},"page":"e119027","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["How is access to palliative care negotiated and accomplished among Muslim immigrants and their direct descendants in Germany, and what culturally and religiously framed narrative resources shape meaning-making in serious illness and approaching death? A multicentre four-group qualitative study using constructivist Grounded theory and Narrative inquiry"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6999-1975","authenticated-orcid":false,"given":"Florian","family":"Bernhardt","sequence":"first","affiliation":[{"name":"Department of Palliative Care, University Hospital M\u00fcnster, M\u00fcnster, Germany"},{"name":"Department of Medicine A, Hematology, Oncology, Hemostaseology and Pulmonology, University Hospital M\u00fcnster, M\u00fcnster, Germany"},{"name":"West German Cancer Center Consortium (WTZ), Network Partner M\u00fcnster, University Hospital M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferya","family":"Banaz-Ya\u015far","sequence":"additional","affiliation":[{"name":"Department of Hospice Care, University Hospital Essen, Essen, Germany"},{"name":"West German Cancer Center Consortium (WTZ), Network Partner Essen, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Rosa","family":"Salvador Comino","sequence":"additional","affiliation":[{"name":"West German Cancer Center Consortium (WTZ), Network Partner Essen, University Hospital Essen, Essen, Germany"},{"name":"Department of Palliative Medicine, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Altscher","sequence":"additional","affiliation":[{"name":"St. Franziskus-Hospital Ahlen, Academic Teaching Hospital of the University of M\u00fcnster, Ahlen, Germany"},{"name":"Specialised Outpatient Palliative Care Service Warendorf, Warendorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard","family":"Dasch","sequence":"additional","affiliation":[{"name":"Department of Palliative Care, University Hospital M\u00fcnster, M\u00fcnster, Germany"},{"name":"West German Cancer Center Consortium (WTZ), Network Partner M\u00fcnster, University Hospital M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Terborg","sequence":"additional","affiliation":[{"name":"Department of Palliative Care, University Hospital M\u00fcnster, M\u00fcnster, Germany"},{"name":"West German Cancer Center Consortium (WTZ), Network Partner M\u00fcnster, University Hospital M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Scheer","sequence":"additional","affiliation":[{"name":"Department of Hospice Care, University Hospital Essen, Essen, Germany"},{"name":"West German Cancer Center Consortium (WTZ), Network Partner Essen, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janina","family":"Kr\u00fcger","sequence":"additional","affiliation":[{"name":"Specialised Outpatient Palliative Care Service M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Rene","family":"Steike","sequence":"additional","affiliation":[{"name":"West German Cancer Center Consortium (WTZ), Network Partner M\u00fcnster, University Hospital M\u00fcnster, M\u00fcnster, Germany"},{"name":"Department of Radiation Oncology, University Hospital M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8868-8329","authenticated-orcid":false,"given":"Mitra","family":"Tewes","sequence":"additional","affiliation":[{"name":"West German Cancer Center Consortium (WTZ), Network Partner Essen, University Hospital Essen, Essen, Germany"},{"name":"Department of Palliative Medicine, University Hospital Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Lenz","sequence":"additional","affiliation":[{"name":"Department of Palliative Care, University Hospital M\u00fcnster, M\u00fcnster, Germany"},{"name":"West German Cancer Center Consortium (WTZ), Network Partner M\u00fcnster, University Hospital M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"2026061905453041000_16.6.e119027.1","doi-asserted-by":"crossref","unstructured":"McAuliffe M , Oucho LA . 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