Oncologists communicating with patients about assisted dying

Abstract

Purpose of reviewAcross all jurisdictions in which assisted dying is legally permissible, cancer is the primary reported underlying diagnosis. Therefore, oncologists are likely to be asked about assisted dying and should be equipped to respond to inquiries or requests for assisted dying. Because Medical Assistance in Dying was legalized in Canada in 2016, it is a relatively new end-of-life practice and has prompted the need to revisit the academic literature to inform communication with patients about assisted dying. Recent findingsWe reviewed applicable literature published in the past 5 years, pertaining to assisted dying and communication. In total, 86 articles were identified, 21 were flagged as relevant to review in detail, and six were included in the review. Key themes included perceived barriers and benefits to communicating with patients on the topic, pragmatic approaches for facilitating the conversation with patients, and the issue of proactively discussing assisted dying by broaching it as an option with patients.

Association of socioeconomic status with medical assistance in dying: a case–control analysis

“…[85][86][87][88] Another possibility is that clinicians dislike controversy and want to avoid appearing callous towards the poor. 89 Our study does not determine the appropriateness of medical assistance in dying and, for many, the choice is unthinkable. [90][91][92] The observed unequal treatment might also reflect fallible intuition.…”

Barriers and facilitators to medical assistance in dying (MAID) discussions in primary care

“…Only 2 of the total 12 references (Kelly & Varghese, 2006;Mulder et al, 2009) were published earlier than 2010, demonstrating an increase in MAiD-related research worldwide. Most references reviewed were qualitative in nature, with other research designs including scoping reviews and literature reviews (Selby & Bean, 2019;Brooks, 2019), case studies (Tuffrey-Wijne, Curfs, Finlay, & Hollins, 2018; Kelly & Varghese, 2006), and experimental studies (Mulder et al, 2009) which made the use of the ILR methodology ideal. Articles included participants from several medical subspecialties such as oncology, neurology, geriatrics, psychiatry, palliative care, and other health professionals including social workers, palliative caregivers, and hospice staff (Brassfield & Buchbinder, 2020;Tuffrey-Wijne et al, 2018;Brooks, 2019).…”

“…After collating the data, evaluating it, and summarizing the results, facilitators and barriers that affected the discussion of MAiD between PCPs and patients were divided into intrinsic and interpersonal factors. Intrinsic factors included PCP emotions, values, beliefs, education, and training, while interpersonal factors included communication, relationship, and administrative burdens (Brooks, 2019;Brassfield & Buchbinder, 2020;Selby & Bean, 2019;Kelly & Varghese, 2006;Pasman, Willems, & Onwuteaka-Philipsen, 2013;Hagens, Onwuteaka-Philipsen, & Pasman, 2017).…”

“…Based on the findings of this review, strategies to promote MAiD discussions between PCPs and patients were outlined. Recommendations included identifying and addressing values, beliefs, and emotions; developing communication skills and strategies; promoting patient-provider relationships; and mitigating administrative burdens (Kelly & Varghese, 2006;Selby & Bean, 2019;Pasman et al, 2013;Brooks, 2019). As MAiD-related research in Canada progresses through its pioneering phase, future research has been suggested to support the development of communication guides specific to MAiD as well as the evaluation of PCP approaches to MAiD discussions within the Canadian primary care setting (Selby & Bean, 2019;Brooks, 2019).…”

“…Recommendations included identifying and addressing values, beliefs, and emotions; developing communication skills and strategies; promoting patient-provider relationships; and mitigating administrative burdens (Kelly & Varghese, 2006;Selby & Bean, 2019;Pasman et al, 2013;Brooks, 2019). As MAiD-related research in Canada progresses through its pioneering phase, future research has been suggested to support the development of communication guides specific to MAiD as well as the evaluation of PCP approaches to MAiD discussions within the Canadian primary care setting (Selby & Bean, 2019;Brooks, 2019). Keywords: MAiD, primary care, discussion Introduction "Do I believe that unexpected things happen and that the dying process can provide a lot of meaning and value for families and patients?…”