Hospice care providers experiences of grappling with medical assistance in dying in a hospice setting: a qualitative descriptive study

Abstract

Background Rapid implementation of Medical Assistance in Dying (MAiD) across care settings has challenged providers and organizations, including hospices, to develop and implement new modes of practice. The aim of this study was to examine the effects that legalization of MAiD has had on hospice care provider roles within the non-provider context. Methods Eight in-depth semi-structured interviews were conducted and a qualitative descriptive approach used to examine hospice care providers experiences in a small western Canadian city. In the study context, patients who choose MAiD are cared for until immediately prior to the procedure when they are transferred off-site to undergo MAiD. Inductive and thematic analyses were undertaken. Results Participants experienced practical, philosophical, and professional challenges. Despite the overwhelming desire to support patient autonomy and decision-making, some interpreted patient choice for MAiD as rejection of the natural death experience at the hospice. Patient choice for MAiD initiated a new and different pathway of end-of-life care. While participants felt uncertain how best to support patients undergoing MAiD, they shared mixed optimism on how their care provider roles were evolving as their level of experience broadened. While implementation of MAiD was rapid, the introduction of practical and professional supports has remained slow to materialize, leaving many providers to navigate their own personal and professional positions and practices. Conclusion Care providers require a multi-faceted range of clinical, legal, and logistical supports at the practice, organizational, and health system levels, to facilitate care delivery to those requesting and undergoing MAiD and to promote coordinated and holistic patient-centered care. The different pathway for those who chose MAiD may lead care providers to struggle with relational challenges and interpersonal unease. Further research may address how to support those undergoing MAiD within the hospice context.

Medical assistance in dying in hospice: A qualitative study

“…Our results also extend previous findings that a hospice’s response to legalisation can create challenges for a hospice and its staff 8 10. Specifically, our results aligned with and elaborated those of Freeman et al that demonstrated how the separation of MAID and hospice care can lead to communication issues among staff, and a feeling among hospice staff of being disconnected from the patient’s care surrounding MAID 10. These feelings were most pronounced when a patient was transferred off-site to receive MAID, with staff in our study reporting distress with this occurrence 10.…”

“…Our results provide insight into the challenges and opportunities MAID brings to Canadian hospices. Like Freeman et al , our findings highlight that the introduction of MAID has left many hospice staff struggling to reconcile patient requests for MAID with their own beliefs regarding hospice facilities and hospice care 10. Since its inception in 1967, the modern hospice movement has been rooted in providing a certain dying experience, in which the patient’s end-of-life needs are addressed through holistic comfort care, enabling the patient to find meaning as they face their upcoming death alongside their family and friends 18–20.…”

“…Like Freeman et al , our participants also found assisted dying to be uncomfortably quick in contrast to the longer approach to death common in hospice 10. Similarly, our participants struggled to accept a patient’s request for MAID, sometimes feeling that the care they offered had failed the patient 10…”

“…To many in the hospice community, assisted dying offers a contrasting dying experience, with participants in our study commenting on how the death offered by MAID is fundamentally incompatible with that offered by hospice, as they felt it does not allow staff to focus on providing the patient with comfort and quality of life and death 7 21 22. Like Freeman et al , our participants also found assisted dying to be uncomfortably quick in contrast to the longer approach to death common in hospice 10. Similarly, our participants struggled to accept a patient’s request for MAID, sometimes feeling that the care they offered had failed the patient 10…”

“…Research on the experiences of Canadian hospice palliative care workers since legalisation has shown challenges have emerged, including emotional and ethical difficulties for staff 8–10. However, there have been few studies exclusively examining the experiences of Canadian hospices since legalisation.…”