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.

BACKGROUND

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.

AIM: We explored access to palliative care among this population, developed an explanatory model of access dynamics and reconstructed culturally and religiously framed narrative resources.

DESIGN

We conducted a qualitative, multicentre, four-group study using constructivist Grounded theory with complementary Narrative inquiry. Loosely structured interviews followed Kaufmann's 'L'entretien compréhensif' between August 2021 and December 2022.

SETTING/

PARTICIPANTS

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).

RESULTS

The Grounded theory SAME SAME BUT DIFFERENT 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) Othering/Belonging, (II) Information/Representation, (III) Role of the family, (IV) Palliative stigma, (V) 'Language barrier' as a multidimensional challenge and (VI) Dealing with life crisis, illness and death.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.Narrative inquiry reconstructed four culturally and religiously framed narrative resources that shaped access decisions.

CONCLUSIONS

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.