How We Can Improve the Quality of Care for Patients Requesting Medical Assistance in Dying: A Qualitative Study of Health Care Providers

Oczkowski, Simon; Crawshaw, D; Austin, Peggy; Versluis, Donald; Kalles-Chan, Gaelen; Kekewich, Mike; Curran, Dorothyann; Miller, Paul; Kelly, Michaela; Wiebe, Ellen; Dees, Marianne; Frolic, Andrea

doi:10.1016/j.jpainsymman.2020.08.018

Cited by 23 publications

(38 citation statements)

References 25 publications

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“…A review of empirical evidence from the Canadian context post-MAID implementation provides insight into significant factors influencing early experiences. From a systems perspective, many were struggling to set up processes that ensured patient-centered care and accessibility [19], particularly in light of the limited numbers of assessors and providers available [20], and the heavy workloads on those who were willing and able to provide MAID services [21]. Accessibility to MAID was influenced by the sometime contentious relationship between those care providers involved in MAID and those in palliative care [19,22,23].…”

Section: Request Signed By One Independent Witnessmentioning

confidence: 99%

“…Accessibility to MAID was influenced by the sometime contentious relationship between those care providers involved in MAID and those in palliative care [19,22,23]. There was a need to support healthcare providers involved in MAID in light of the emotional impact [20,24,25] and a need to provide healthcare providers with the knowledge and skills to assist with, or to assess and provide, MAID, particularly in light of vague eligibility criteria [20,26,27]. There was also a need to manage the relational challenges that arose between those who saw MAID as an acceptable moral option and those who did not [19-21, 25, 26].…”

Section: Request Signed By One Independent Witnessmentioning

confidence: 99%

“…There was also a need to manage the relational challenges that arose between those who saw MAID as an acceptable moral option and those who did not [19-21, 25, 26]. Caring for families throughout the process and into bereavement has consistently been one of the most challenging aspects of MAID [20,28,29]. Given the potential impact of these factors on the quality of care provided through MAID, and on the ongoing debate about the relationship between MAID and palliative care, it is important to understand how MAID is evolving over time within a larger systems perspective.…”

Section: Request Signed By One Independent Witnessmentioning

confidence: 99%

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Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

Pesut

Thorne

Wright

et al. 2021

BMC Health Serv Res

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Background Even as healthcare providers and systems were settling into the processes required for Medical Assistance in Dying (MAID) under Bill C-14, new legislation was introduced (Bill C-7) that extended assisted death to persons whose natural death is not reasonably foreseeable. The purpose of this paper is to describe the experiences of nurses and nurse practitioners with the implementation and ongoing development of this transition. Methods This qualitative longitudinal descriptive study gathered data through semi-structured telephone interviews with nurses from across Canada; cross sectional data from 2020 to 2021 is reported here. The study received ethical approval and all participants provided written consent. Findings Participants included nurses (n = 34) and nurse practitioners (n = 16) with significant experience with MAID. Participants described how MAID had transitioned from a new, secretive, and anxiety-producing procedure to one that was increasingly visible and normalized, although this normalization did not necessarily mitigate the emotional impact. MAID was becoming more accessible, and participants were learning to trust the process. However, the work was becoming increasingly complex, labour intensive, and often poorly remunerated. Although many participants described a degree of integration between MAID and palliative care services, there remained ongoing tensions around equitable access to both. Participants described an evolving gestalt of determining persons’ eligibility for MAID that required a high degree of clinical judgement. Deeming someone ineligible was intensely stressful for all involved and so participants had learned to be resourceful in avoiding this possibility. The required 10-day waiting period was difficult emotionally, particularly if persons worried about losing capacity to give final consent. The implementation of C-7 was perceived to be particularly challenging due to the nature of the population that would seek MAID and the resultant complexity of trying to address the origins of their suffering within a resource-strapped system. Conclusions Significant social and system calibration must occur to accommodate assisted death as an end-of-life option. The transition to offering MAID for those whose natural death is not reasonably foreseeable will require intensive navigation of a sometimes siloed and inaccessible system. High quality MAID care should be both relational and dialogical and those who provide such care require expert communication skills and knowledge of the healthcare system.

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Section: Request Signed By One Independent Witnessmentioning

confidence: 99%

Section: Request Signed By One Independent Witnessmentioning

confidence: 99%

Section: Request Signed By One Independent Witnessmentioning

confidence: 99%

See 1 more Smart Citation

Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

Pesut

Thorne

Wright

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…These projected increases are substantiated as research from international regions with assisted dying reported an increase in the number of patients accessing care over time (Steck et al, 2013). Access to MAID varies throughout Canada (Brown et al, 2020;Oczkowski et al, 2020;Schiller, 2017). Individuals in rural and remote areas experience health care access challenges and poorer health outcomes (Greenburg et al, 2019), and so it is reasonable they will experience MAID access challenges as well.…”

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confidence: 99%

“What Is Right for Me, Is Not Necessarily Right for You”: The Endogenous Factors Influencing Nonparticipation in Medical Assistance in Dying

et al. 2021

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Access to medical assistance in dying (MAID) is influenced by legislation, health care providers (HCPs), the number of patient requests, and the patients’ locations. This research explored the factors that influenced HCPs’ nonparticipation in formal MAID processes and their needs to support this emerging practice area. Using an interpretive description methodology, we interviewed 17 physicians and 18 nurse practitioners who identified as non-participators in formal MAID processes. Nonparticipation was influenced by their (a) previous personal and professional experiences, (b) comfort with death, (c) conceptualization of duty, (d) preferred end-of-life care approaches, (e) faith or spirituality beliefs, (f) self-accountability, (g) consideration of emotional labor, and (h) future emotional impact. They identified a need for clear care pathways and safe passage. Two separate yet overlapping concepts were identified, conscientious objection to and nonparticipation in MAID, and we discussed options to support the social contract of care between HCPs and patients.

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“…However, additional data are needed to evaluate and improve the service (eg, feedback from providers, patients and families, analyses of the process including its policy, functionality, efficiency, effectiveness, impacts and sustainability and so on). 24 Canadian providers and health systems are actively working to improve the MAID experiences of patients, families and professionals, [25][26][27][28] but it remains challenging to improve its implementation without knowing what the process looks like. Studies describing professional roles, expectations and knowledge gaps 9 15 29-32 or how MAID was implemented 4 5 9 33-37 provide few details about the process itself (eg, how work is coordinated between professionals, which professional(s) do which activities and when and so on).…”

Section: Introductionmentioning

confidence: 99%

How is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study

et al. 2021

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ObjectivesThe aims of this study are: (1) to create a flowchart process model of how medical assistance in dying (MAID) occurs in Nova Scotia (NS), Canada and (2) to detail how NS healthcare professionals are involved in each stage of MAID. The research questions are: how is the MAID process carried out and which professionals are involved at which points? and which roles and activities do professionals carry out during MAID?DesignQualitative process model flowchart study with semistructured interviews.SettingPrimary and secondary care in NS, Canada.ParticipantsThirty-two interviewees self-selected to participate (12 physicians, 3 nurse practitioners (NP), 6 nurses, 6 pharmacists and 5 healthcare administrators and advocates). Participants were included if they conduct assessments, provide MAID, fill prescriptions, insert the intravenous lines, organise care and so on.ResultsThe flowchart process model details five stages of how MAID occurs in NS: (1) starting the MAID process, (2) MAID assessments, (3) MAID preparation (hospital in-patient, hospital outpatient, non-hospital), (4) day of MAID and (5) post-MAID (hospital in-patient and outpatient, non-hospital, after leaving setting). Nineteen points where the process could stop or be delayed were identified. MAID differs slightly by location and multiple professionals from different organisations are involved at different points. Some physicians and NP provide MAID for free as they cannot be reimbursed or find it too difficult to be reimbursed.ConclusionsOur study adds knowledge about the MAID activities and roles of NS professionals, which are not documented in the international literature. Clinicians and pharmacists spend significant additional time to participate, raising questions about MAID’s sustainability and uncompensated costs. The process model flowchart identifies where MAID can stop or be delayed, signalling where resources, training and relationship-building may need to occur. Knowing where potential delays can occur can help clinicians, administrators and policymakers in other jurisdictions improve MAID.

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How We Can Improve the Quality of Care for Patients Requesting Medical Assistance in Dying: A Qualitative Study of Health Care Providers

Cited by 23 publications

References 25 publications

Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

Navigating medical assistance in dying from Bill C-14 to Bill C-7: a qualitative study

“What Is Right for Me, Is Not Necessarily Right for You”: The Endogenous Factors Influencing Nonparticipation in Medical Assistance in Dying

How is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study

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