title: "If I had stayed back home, I would not be alive any more…" - Exploring end-of-life preferences in patients with migration background.
abstract: BACKGROUND
  In patients with life-limiting conditions and a history of migration, a higher risk of not dying at home and limited access to palliative care services has been reported.
  
  
  OBJECTIVE
  To explore the views and end-of-life preferences of patients with a migration history in Germany and to identify migration specific themes.
  
  
  METHODS
  Two-armed study using Kaufmann's 'understanding interview' ('focused interview') method and grounded theory approach. Thematic content analysis was applied using MaxQDA 12 software.
  
  
  METHODS
  Migrant and non-migrant adult patients with far advanced, life-limiting disease receiving palliative care in different specialist level settings (specialist home palliative care, palliative care inpatient unit, inpatient hospice).
  
  
  RESULTS
  The 37 interviewees (19 native Germans and 18 patients from Europe and the U.S., Israel, Turkey, and Indonesia) expressed eleven themes covering health care- and patient-related issues, of which four emerged to be specific for migrants: worse survival in home country; the perception of an altered identity and 'not belonging'; language skills as prerequisite to survive; and longing for 'home' while being attached to Germany. From these categories, three overarching themes were derived: (1) a limited understanding of the concept of 'palliative care'; (2) the suppression of end of life discussions for its association with suffering and loss of autonomy; and (3) the significance of complex individual migration histories.
  
  
  CONCLUSIONS
  Based on these findings, the concept of a 'double home' experience is proposed. Barriers to access to palliative care should be minimized for all patients while cultural stereotyping has to be avoided.
authors.affiliation: Department of Research and Development, Hospice Care DaSein, Munich, Germany.
authors.forename: Piret
authors.initials: P
authors.lastname: Paal
authors.affiliation: Department of Research and Development, Hospice Care DaSein, Munich, Germany.|Institute of Nursing Sciences and Palliative Care, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Johannes
authors.identifier: http://orcid.org/0000-0003-1232-1103
authors.initials: J
authors.lastname: Bükki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004641:Emigration and Immigration; D005260:Female; D005858:Germany; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D013727:Terminal Care