Characteristics of Older Adults Accessing Medical Assistance in Dying (MAiD): a Descriptive Study.
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SUBMITTER: Selby D
PROVIDER: S-EPMC8629503 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Aims and objectivesTo describes nurses' moral experiences with Medical Assistance in Dying in the Canadian context.BackgroundNurses perform important roles in Medical Assistance in Dying in Canada and do so within a unique context in which Medical Assistance in Dying is provided through healthcare services and where accessibility is an important principle. International literature indicates that participating in Medical Assistance in Dying can be deeply impactful for nurses and requires a high degree of moral sense-making.DesignA qualitative interview study guided by Interpretive Description using the COREQ checklist.ResultsFifty-nine nurses from across Canada participated in the study. The decision to participate in Medical Assistance in Dying was influenced by family and community, professional experience and nurses' proximity to the act of Medical Assistance in Dying. Nurses described a range of deep and sometimes conflicting emotional reactions provoked by Medical Assistance in Dying. Nurses used a number of moral waypoints to make sense of their decision including patient choice, control and certainty; an understanding that it was not about the nurse; a commitment to staying with patients through suffering; consideration of moral consistency; issues related to the afterlife; and the peace and gratitude demonstrated by patients and families.DiscussionThe depth of nurses' intuitional moral responses and their need to make sense of these responses are consistent with Haidt's theory of moral experience in which individuals use reasoning primarily to explain their moral intuition and in which moral change occurs primarily through compassionate social interaction. Further, work on the moral identity of nursing provides robust explanation of how nurses' moral decisions are contextually and relationally mediated and how they seek to guard patient vulnerability, even at their own emotional cost.ConclusionMedical Assistance in Dying is impactful for nurses, and for some, it requires intensive and ongoing moral sense-making.Relevance to clinical practiceThere is a need to provide support for nurses' moral deliberation and emotional well-being in the context of Medical Assistance in Dying care.
| S-EPMC7540490 | biostudies-literature
Project description: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.
| S-EPMC8314721 | biostudies-literature
Project description:ObjectivesTo assess SGO members' knowledge, attitudes, and practice patterns regarding Medical Aid In Dying (MAID).MethodsSGO members were surveyed via online survey. The survey included questions regarding demographics, knowledge, attitudes, and practice patterns relating to MAID. Descriptive statistics were calculated. Associations between sociodemographic factors and attitudes related to MAID were analyzed utilizing logistic regression.ResultsOf 1,337 invited members, 225 (17%) responded. Median age was 46. Most were female (58%), white (81%), and in academic practice (64%). Over 50% had heard the term MAID and have had a patient ask about it. Few (20%) reported living in a state where MAID is legal and 61% of these respondents provided MAID. Sixty percent lived in a state that had not legalized MAID and 18% did not know if MAID was legal in their state. 36% of respondents living in a state where MAID was illegal/unknown legality indicated they would provide MAID if it were legal in their state, 30% would not, and 34% were uncertain. The majority (69%) of respondents believed MAID should be legal. Female respondents were more likely to support legalization of MAID (OR 2.44, p=<0.05). Respondents practicing in the southern U.S. were less likely to support legalization of MAID (OR 0.42, p=<0.05). Over 75% of respondents stated an SGO position statement on MAID would be helpful.ConclusionsMAID is a highly relevant topic for gynecologic oncologists. Gaps in MAID-related knowledge exist among SGO members and there is a desire for additional education and guidance regarding MAID.
| S-EPMC8271105 | biostudies-literature
Project description:ObjectiveTo examine how Canadian newspapers portrayed physicians' role and medical assistance in dying (MAiD).DesignQualitative textual analysis.SettingOnline and print articles from Canadian French and English newspapers.Participants813 newspaper articles published from 1972 to 2016.ResultsKey Canadian events defined five eras. From 1972 to 1990, newspapers portrayed physician's MAiD role as a social issue by reporting supportive public opinion polls and revealing it was already occurring in secret. From 1991 to 1995, newspapers discussed legal aspects of physicians' MAiD role including Rodriguez' Supreme Court of Canada appeal and Federal government Bills. From 1996 to 2004, journalists discussed professional aspects of physicians' MAiD role and the growing split between palliative care and physicians who supported MAiD. They also reported on court cases against Canadian physicians, Dr Kevorkian and suffering patients who could not receive MAiD. From 2005 to 2013, newspapers described political aspects including the tabling of MAiD legislation to change physicians' role. Lastly, from 2014 to 2016, newspapers again portrayed legal aspects of physicians' role as the Supreme Court of Canada was anticipated to legalise MAiD and the Québec government passed its own legislation. Remarkably, newspapers kept attention to MAiD over 44 years before it became legal. Articles generally reflected Canadians' acceptance of MAiD and physicians were typically portrayed as opposing it, but not all did.ConclusionsNewspaper portrayals of physicians' MAiD role discussed public opinion, politicians' activities and professional and legal aspects. Portrayals followed the issue-attention cycle through three of five stages: 1) preproblem, 2) alarmed discovery and euphoric enthusiasm and 3) realising the cost of significant progress.
| S-EPMC6502060 | biostudies-literature
Project description:BackgroundOn June 17, 2016, providing medical assistance in dying became legal in Canada. This controversial change has had reverberating implications for the entire medical community. This is especially true for physicians that regularly deal with end-of-life decisions, among them neurosurgical and orthopedic spine surgeons, whose patients suffer from a variety of debilitating conditions. With this study we sought to document the opinions of Canadian spine surgeons in hopes of better understanding the sentiment within the speciality towards this change and assess how it evolves over time.MethodsA cross-sectional survey was sent out to members of the Canadian Spine Society (CSS). The survey encompassed 21 questions pertaining to opinions and attitudes regarding MAID and different facets of the legislation.ResultsA total of 51 surgeons responded to the survey, comprised of a mix of orthopedic surgeons (68.6%), pediatric orthopedic surgeons (5.9%), and neurosurgeons (21.6%), practicing all across Canada. The majority support the patients' right to obtain MAID (62.8%) and the right of physicians to participate (82.4%). Most also support the right to conscientious objection (90.1%). The results were split on duty to refer patients for MAID (49.0%). Respondents were also divided on whether they could foresee themselves referring to a MAID service, with 37.2% responding yes. A small minority of respondents (3.9%) felt they could see themselves actively involved in MAID.ConclusionsAt the advent of legal MAID, the majority of members of the CSS supported both the right of patients to participate in MAID and the right of physicians to provide this service if they so choose, while still respecting the principle of conscientious objection. Of note, only a small minority were willing to be actively involved. This survey provides a useful baseline of opinions in this practice area and will be used to analyze changes over the next 10 years.
| S-EPMC8820034 | biostudies-literature
Project description:BackgroundPharmacists in many countries have long been involved in some aspect of assisted dying. Since 2016, when Canada enacted legislation permitting medical assistance in dying (MAiD), the number of patients seeking the procedure has increased yearly. Despite the global nature of pharmacists' involvement, little is known about how they experience MAiD practice.ObjectiveTo study how pharmacists experience the practice of caring for patients who seek MAiD.MethodsThis qualitative study used semistructured interviews with pharmacists who had cared for patients seeking MAiD. Interviews, conducted between June 2019 and October 2020, were audio-recorded and transcribed verbatim. Data were examined using a modified framework analysis approach. Data were coded and sorted using Quirkos and Microsoft Excel software. Themes were defined through an iterative process involving constant comparison.ResultsNineteen hospital pharmacists representing a range of practice settings in Alberta participated in the study. The experience of caring for patients seeking assistance in dying brought to light 3 themes: finding a place in the process, serving in a caring role, and bearing emotional burdens. Pharmacists' experiences were personal, relational, emotional, and dynamic.ConclusionsEach of the pharmacists experienced MAiD practice in a unique way. Although their roles in MAiD were primarily medication-focused, their experiences highlighted the centrality of patient choices, autonomy, and needs. The results of this study will inform pharmacists (including those not yet engaged in MAiD practice) about the role, and will also be valuable for pharmacy organizations and educators seeking to support pharmacists and the profession, as well as policy-makers seeking to expand pharmacists' roles in MAiD.
| S-EPMC9524557 | biostudies-literature
Project description:BackgroundMedical students can enhance their knowledge by accessing patients' medical records and documenting patient care. This study assessed medical students' access to paper medical records and electronic health records (EHRs) in Saudi Arabia and compared students' experience of accessing paper medical records and EHR from their perspective.MethodsThis cross-sectional study enrolled second-year to intern medical students randomly from different medical colleges in Saudi Arabia. A self-developed survey was administered to them. It comprised 28 items in three sections: general information about medical students and their level of accessing medical records, their experience with the medical record system used in hospitals, and their preference for the medical record type.Results62.8% of participants had access to medical records, with 66.1% of them having access to EHRs and 83.27% had read-only access. The EHR group and paper group mostly liked being able to reach medical records effortlessly (70.1% and 67.1%, respectively). The EHR group had a better experience compared to the paper group with U = 5200, Mean Rank = 122.73, P = .04. Students who trained in University - owned and National Guard hospitals had better experiences compared to students who trained in other hospitals with Mean Ranks =122.35, and 147.99, respectively.ConclusionIncorporating EHR access into the medical curriculum is essential for creating new educational opportunities that are not otherwise available to medical students.
| S-EPMC8117651 | biostudies-literature
Project description:BackgroundMedical assistance in dying (MAID) was legalized in Canada in 2016. As of July 2017, approximately 2149 patients have accessed MAID. There remains no national-level data on the perspectives of future physicians about MAID or its changing legal status. We provide evidence from a national survey of Canadian medical students about their opinions, intentions, and concerns about MAID.MethodsFrom October 2016 to July 2017, we distributed an anonymous online survey to all students at 15 of Canada's 17 medical schools. The survey collected data on respondent socio-demographic characteristics, features of their medical education, intentions for medical practice, and perspectives on MAID. We analyzed responses using univariate descriptive and stepwise multivariate logistic regression.ResultsIn 1210 completed surveys, 71% of respondents reported being willing to provide MAID under a legal framework that permits it. Non-religious respondents reported greater willingness to participate in MAID than respondents of any religious affiliation (p < 0.001). Frequency of religious attendance was inversely associated with willingness to provide MAID (p < 0.001). Medical students born in Québec were more willing to provide MAID than respondents from other provinces (OR 2.21; p < 0.001). Age, sex, socioeconomic status, year of medical study, previous academic major, and rural/urban city of birth were not associated with willingness to provide MAID.ConclusionAs the current class of medical students becomes the first cohort of new physicians to enter Canada's changing medical and legal landscape around MAID, our findings inform the public debate by examining attributes associated with support or opposition to the practice.
| S-EPMC6444527 | biostudies-literature
Project description:IntroductionMedical assistance in dying (MAID), a term encompassing both euthanasia and assisted suicide, was decriminalised in Canada in 2015. Although Bill C-14 legislated eligibility criteria under which patients could receive MAID, it did not provide guidance regarding the technical aspects of providing an assisted death. Therefore, we propose a scoping review to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of MAID, in order to identify knowledge gaps and areas for future research.Methods and analysisWe will search electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO), clinical trial registries, conference abstracts, and professional guidelines and recommendations from jurisdictions where MAID is legal, up to June 2017. Eligible report types will include technical summaries, institutional policies, practice surveys, practice guidelines and clinical studies. We will include all descriptions of MAID provision (either euthanasia or assisted suicide) in adults who have provided informed consent for MAID, for any reason, including reports where patients have provided consent to MAID in advance of the development of incapacity (eg, dementia). We will exclude reports in which patients receive involuntary euthanasia (eg, capital punishment). Two independent investigators will screen and select retrieved reports using pilot-tested screening and eligibility forms, and collect data using standardised data collection forms. We will summarise extracted data in tabular format with accompanying descriptive statistics and use narrative format to describe their clinical relevance, identify knowledge gaps and suggest topics for future research.Ethics and disseminationThis scoping review will map the range and scope of the existing literature on the provision of MAID in jurisdictions where the practice has been decriminalised. The review will be disseminated through conference presentations and publication in a peer-reviewed journal. These results will be useful to clinicians, policy makers and researchers involved with MAID.
| S-EPMC5724208 | biostudies-literature
Project description:BACKGROUND:To facilitate access to medical assistance in dying (MAiD) in British Columbia, telemedicine has been used for eligibility assessments. This research explored the impacts of using telemedicine on quality of care. METHODS:This mixed-methods study consisted of data from 3 BC health authorities and semistructured interviews with a patient, support persons, providers and administrators about the use of telemedicine for MAiD eligibility assessment. Interviews were conducted by telephone, video meeting or email between June and November 2018. We analyzed the quantitative data using descriptive statistics. We categorized the qualitative data using the 7 dimensions of the BC Health Quality Matrix and then analyzed them qualitatively with abductive coding. RESULTS:Twenty-one participants (8 MAiD assessors, 1 patient, 7 support persons of patients and 5 MAiD administrators) were interviewed. Telemedicine for MAiD eligibility assessments was highly acceptable to the support persons and patient and to most assessors and administrators. Assessors expressed challenges with empathy, eye contact, nonverbal communication and missing contextual factors. Participants described which patients were appropriate and which were not. Telemedicine improved access and equity for the patients who received this service. It was perceived as an effective and efficient way to perform eligibility assessments. Concerns were expressed by assessors and administrators, but not by the patient or support persons, about confidentiality. Opinions varied on the requirement for a regulated health care professional to be in physical attendance with the patient to act as a witness. INTERPRETATION:Quality of care can be achieved with telemedicine for MAiD eligibility assessments for specific situations and patients, and this modality has the potential to expand access to MAiD. Updated clinical and administrative policies are needed to address barriers to telemedicine access and to best support patients and assessors using this technology.
| S-EPMC6910140 | biostudies-literature