How We Can Improve the Quality of Care for Patients Requesting Medical Assistance in Dying: A Qualitative Study of Health Care Providers |
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| Authors: | Simon J.W. Oczkowski Diane Crawshaw Peggy Austin Donald Versluis Gaelen Kalles-Chan Mike Kekewich Dorothyann Curran Paul Q. Miller Michaela Kelly Ellen Wiebe Marianne Dees Andrea Frolic |
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| Affiliation: | 1. Department of Medicine, McMaster University, Hamilton, Ontario, Canada;2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;3. Hamilton Health Sciences, Hamilton, Ontario, Canada;4. School of Nursing, McMaster University, Hamilton, Ontario, Canada;5. Vancouver Island Health Authority, Victoria, British Columbia, Canada;6. Department of Clinical and Organizational Ethics, The Ottawa Hospital, Ottawa, Ontario, Canada;7. The Ottawa Hospital, Ottawa, Ontario, Canada;8. Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada;9. London School of Hygiene and Tropical Medicine, London, England;10. Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada;11. Q Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands;12. Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada;1. University of Pennsylvania, Philadelphia, Pennsylvania, USA;2. St. Luke''s University Health Network, Bethlehem, Pennsylvania, USA;1. Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy;2. IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy;3. Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy;4. ASST- Santi Paolo e Carlo, University of Milan, Milan, Italy;5. ASST-Rhodense, Palliative Care, Hospice and Pain Therapy Department, Garbagnate Milanese, Milan, Italy;6. ASST Grande Ospedale Metropolitano Niguarda, Palliative Care – Hospice, Milan, Italy;7. ASST-Lariana, Palliative Care – Hospice, Mariano Comense, Como, Italy;8. ASST-Rhodense Bachelor School of Nursing, University of Milan, Rho, Milan, Italy;9. ASST-Rhodense, Garbagnate Milanese, Milan, Italy;10. Palliative Care Department Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan;11. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy;1. Emergency Department of Rebagliati Hospital EsSalud, Medicine School, Universidad Nacional Mayor de San Marcos, Lima, Peru;2. Medicine Department of Almenara Hospital EsSalud, Medicine School, Universidad Nacional Mayor de San Marcos, Lima, Peru;3. Department of Palliative Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA;1. Yale Palliative Care Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA;2. Stanford University School of Medicine, Palo Alto, California, USA;3. Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA;4. University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, Alabama, USA;5. Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;6. Department of Medicine, University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas, USA;7. Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA;1. The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA;2. Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA;3. Patient and Family Advisors, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA;1. Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA;2. University of Colorado Hospital, Aurora, CO, USA;3. Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA;4. Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA |
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| Abstract: | ContextSince Canada decriminalized medical assistance in dying (MAID) in 2015, clinicians and organizations have developed policies and protocols to implement assisted dying in clinical practice. Five years on, there is little consensus as to what constitutes high-quality care in MAID.ObjectivesTo describe MAID clinicians' perspectives on quality of care in MAID, including challenges, successes, and clinical practice suggestions.MethodsWe conducted an exploratory, multicenter, and qualitative study at four Canadian centers. Using a semistructured interview guide, we conducted interviews with 20 health care providers. Interviews were transcribed and deidentified before analysis. Adopting a qualitative descriptive approach, we used a thematic analysis to identify primary and secondary themes in the interviews and practice suggestions to improve quality of care to patients who request MAID.ResultsWe identified three major themes. 1) Improving access and patient experience: clinicians described struggles in ensuring equitable access to MAID and supporting MAID patients and their families. 2) Supporting providers and sustainability: clinicians described managing MAID workload, remuneration, educational needs, and the emotional impact of participating in assisted dying. 3) Institutional support: descriptions of MAID communication tools and training, use of standardized care pathways, interprofessional collaboration, and human resource planning. Clinicians also described suggestions for clinical practice to improve quality of care.ConclusionCanadian health care providers described unique challenges in caring for patients who request MAID, along with practices to improve the quality of care. |
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| Keywords: | Medical assistance in dying euthanasia assisted suicide quality of care |
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