title: Developing a palliative care service model for Muslim Middle Eastern countries.
abstract: OBJECTIVE
  Palliative Care (PC) was first introduced to Muslim Middle Eastern (MME) countries in 1992, but growth of PC has been slow and access to PC is still limited in the region. While most PC models have been developed in Western countries, MME societies have different cultural and religious values that are not incorporated in Western models. We conducted a qualitative study to look at these differences, in order to inform a culturally acceptable model of PC that meets the needs of MME patients and their families.
  
  
  METHODS
  We conducted semi-structured interviews of PC physicians and nurses with experience in both Western and MME countries. Participants were identified by snowball sampling. Interviews were transcribed and analyzed using a modified grounded-theory approach.
  
  
  RESULTS
  We achieved conceptual saturation after 13 interviews. Participants identified four differences between PC practice in Western and MME countries including: cultural differences, legal and policy differences, stances on PC philosophy, and the availability of resources and support for PC. Participants identified five barriers to advancing PC in the MME: shortage of resources, unclear laws and policies, healthcare system barriers, unfamiliarity with the role and benefits of PC, and cultural barriers. Respondents suggested many facilitators at the institutional, regional, and societal levels.
  
  
  CONCLUSIONS
  We identified a number of important differences in PC practice, as well as common barriers and facilitators for developing PC services in MME countries. This information can help clinicians who are developing PC services in a MME country.
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Center, University Health Network, 610 University Ave., Rm16-575, Toronto, M5G 2M9, Canada, ahmed.al.awamer@mail.utoronto.ca.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Awamer
authors.forename: James
authors.initials: J
authors.lastname: Downar
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D065246:Culturally Competent Care / Q000208:ethnology / Q000458:organization & administration; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007514:Islam / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D020380:Needs Assessment; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration / Q000523:psychology; D036301:Qualitative Research