scholarly journals P009: Medical assistance in dying – a survey of Canadian emergency physicians

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S66
Author(s):  
F. Bakewell
Keyword(s):  
Emergency Medicine ◽  
Terminal Illness ◽  
Free Form ◽  
Medical Attention ◽  
Emergency Physicians ◽  
Medical Assistance ◽  
Electronic Survey ◽  
Medical Assistance In Dying ◽  
Self Harm ◽  
The Impact

Introduction: There have been 3714 medically assisted deaths recorded in Canada so far, with more than half of those deaths occurring outside the hospital – whether this has had any impact on emergency medicine has not yet been documented. This survey sought to find out Canadian emergency physicians’ (EPs) attitudes and experiences with medical assistance in dying (MAID). Methods: An electronic survey was distributed to CAEP members using a modified Dillman technique. The primary outcome was defined as the proportion of EPs in favour of MAID. Secondary outcomes included experience with suicide in the setting of terminal illness, their experience and opinion on referring patients for MAID from the ED, their experience with complications of MAID, and their response to hypothetical cases of complications from MAID. Nominal variables were analyzed and reported as percentages for each relevant answer. Answers submitted as free-form text were coded into themes by the author and reported based on these themes. Results: There were 303 completed surveys. EPs were largely in support of MAID (80.5%), and would be willing to refer patients for assessment from the ED (83.2%), however fewer (58.3%) knew how to do so. 37.1% of EPs had been asked for a referral for MAID assessment, but only 12.5% had made a referral. While only 1% of EPs reported having seen patients present with complications from MAID (failed IVs in the community), 5.0% had seen patients present with suicide or self-harm attempts after being told they were ineligible for MAID by another provider. Conclusion: This is the first study to examine the impact of MAID on emergency medicine in Canada, and it demonstrates that patients are both requesting referrals through the ED and, in rare cases, requiring medical attention for complications. This has implications for both increasing awareness of MAID referral processes for EPs, as well as for the prevention and treatment of complications of MAID in the community.

Impact of medical assistance in dying (MAiD) on family caregivers

2019 ◽  
pp. bmjspcare-2018-001686
Author(s):  
Rachel Goldberg ◽  
Rinat Nissim ◽  
Ekaterina An ◽  
Sarah Hales
Keyword(s):  
Family Caregivers ◽  
Terminal Illness ◽  
Well Being ◽  
Moral Dilemmas ◽  
Future Research ◽  
Anticipatory Grief ◽  
Medical Assistance ◽  
Loved One ◽  
Medical Assistance In Dying ◽  
The Impact

Medical assistance in dying (MAiD) is a globally polarising topic which often sparks debate surrounding the ethical and moral dilemmas that arise with a life-ending intervention. To gain a better understanding of this intervention, it is important to explore the experience of those most intimately affected by MAiD. Family caregivers of those with a terminal illness are the backbone of the healthcare and support team, often providing a substantial amount of informal care while at the same time coping with their own distress and anticipatory grief. However, we know the least about how MAiD impacts the psychosocial well-being of these same individuals. The aim of this article is to explore the experience of MAiD from the family caregiver perspective, namely their beliefs and opinions about the intervention, how the process of MAiD impacts them, how the intervention shapes their view of their loved one’s quality of death, and the psychosocial outcomes after the passing of their loved one. Beyond the literature, challenges within both the clinical and research realms will be discussed and future directions will be offered. While MAiD is currently legal in only a small number of countries, a better understanding of the impact of MAiD will help inform policy and legislation as they are developed in other jurisdictions. Further, this article aims to inform future research and clinical interventions in order to better understand and support those seeking MAiD and their families.

scholarly journals QOLP-26. USE OF MEDICAL ASSISTANCE IN DYING (“DEATH WITH DIGNITY”) IN WASHINGTON STATE PATIENTS WITH BRAIN TUMORS.

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii180-ii180
Author(s):  
Jerome Graber ◽  
Kaite Sofie ◽  
Lynne Taylor
Keyword(s):  
Brain Tumors ◽  
Terminal Illness ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
High Grade Glioma ◽  
Washington State ◽  
Medical Assistance ◽  
Death With Dignity ◽  
Medical Assistance In Dying ◽  
Diagnosis Of Cancer

Abstract Since 2009, Washington State has had a “Death with Dignity” (DWD) process whereby people with a terminal illness may legally obtain a prescription for medications that will end their life. Patients initiate a voluntary request from two physicians certifying they have a prognosis < 6 months, are aware of other palliative care options, and have capacity without the comorbidity of a psychiatric diagnosis. Since 2015, over 200 people annually have used the DWD process in Washington. Other papers have described the characteristics of people using DWD with a diagnosis of cancer or amyotrophic lateral sclerosis (ALS) but none have specifically looked at patients with brain tumors (BT) who used DWD. We describe 20 people with BT who accessed DWD since 2015 at our center. Median age at the time of death was 51 (range 38-79) and 75% were men. Glioblastoma was the diagnosis in 10 (50%), anaplastic glioma in 8 (40%), grade II astrocytoma in 1, and a presumed high-grade glioma by imaging in 1. Median Karnofsky Performance Status (KPS) was 90 at diagnosis (range 50-100) and 70 at DWD request (range 40-90). Standard radiation (RT) and chemotherapy was used by 17 (85%) prior to DWD request, while 3 patients (15%, ages 70-79, KPS 50-90) requested DWD immediately after diagnosis and did not undergo further treatment. Pain was present in 4 patients (20%), 2 using opioids (10%). Six patients (30%) continued tumor treatments after approval for DWD. Median OS was 22 months (range 2-285) and 24 months excluding patients who declined treatment (range 8-285). Most glioma patients in our cohort requested DWD after undergoing chemoradiation, pain was uncommon and rarely severe, and survival from diagnosis was comparable to standard therapy. As access to medical assistance in dying continues, further research is needed on its utilization for people with brain tumors.

Medically Assisted Dying in Canada: “Beautiful Death” Is Transforming Nurses’ Experiences of Suffering

2019 ◽  
pp. 084456211985623 ◽  
Author(s):  
Anne Bruce ◽  
Rosanne Beuthin
Keyword(s):  
End Of Life ◽  
Secondary Analysis ◽  
Emotional Impact ◽  
Assisted Dying ◽  
Medical Assistance ◽  
Narrative Study ◽  
Medical Assistance In Dying ◽  
Qualitative Secondary Analysis ◽  
The Impact

BackgroundNurses witness pain and distress up close and consequently experience their own suffering. A narrative study of Canadian nurses’ participating in medical assistance in dying found nurses’ previous witnessing of unresolved end-of-life suffering has shaped their acceptance of medical assistance in dying. Little is known about the impact of participating in medically assisted dying on nurses’ suffering.PurposeTo explore how nurses’ overall experience of suffering is shaped by participating in medical assistance in dying.MethodsQualitative secondary analysis using narrative inquiry and thematic analysis.ResultsNurses’ narratives are chronologically organized addressing experiences of suffering before medical assistance in dying was a legal option and after its implementation. An overarching narrative before the availability of medical assistance in dying is (1) a culture of nurses’ taken-for-granted suffering: feeling terrible. After medical assistance in dying, two key narratives describe (2) transformational feelings of a beautiful death and (3) residual discomfort. Nurses found their suffering transformed when participating in medical assistance in dying; end-of-life care was satisfying and gratifying. And yet, unanswered questions due to worries of becoming desensitized and ongoing deeper questioning remain.ConclusionsParticipating in medical assistance in dying has positively impacted nurses and starkly contrasts their previous experiences caring for those with unbearable suffering. Further research is needed to explore becoming desensitized and long-term emotional impact for nurses.

Targeted Clinical Education for Staff Attitudes Towards Deliberate Self-Harm in Borderline Personality Disorder: Randomized Controlled Trial

2008 ◽  
Vol 42 (11) ◽  
pp. 981-988 ◽  
Author(s):  
Amanda J. Commons Treloar ◽  
Andrew J. Lewis
Keyword(s):  
Mental Health ◽  
Emergency Medicine ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Clinical Education ◽  
Controlled Trial ◽  
Borderline Personality ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
The Impact

Objective: The aim of the present study was to assess the impact of attending targeted clinical education on borderline personality disorder on the attitudes of health clinicians towards working with deliberate self-harm behaviours commonly exhibited by patients diagnosed with this complex disorder. Comparisons of clinicians across service settings, occupational fields, and other demographic areas were also made. Method: A purpose-designed demographic questionnaire and the Attitudes Towards Deliberate Self-Harm Questionnaire were used to collect the demographic information and assess the attitudes of 99 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service, both before and after education attendance. Results: Statistically significant improvements in attitude ratings were found for both emergency medicine clinicians and mental health clinicians in working with deliberate self-harm behaviours in borderline personality disorder, following attendance at the education program with a medium affect size (t(32)=−3.45, p=0.002, d=0.43 and t(65)=−5.12, p=0.000, d=0.42, respectively). Clinicians across occupational areas of nursing, allied health, and medical fields demonstrated equivocal levels of improvement in their attitude ratings. Conclusions: Results are discussed in terms of the necessity of providing regular access to targeted clinical education for health professionals working with patients diagnosed with borderline personality disorder.

scholarly journals “I Am Okay With It, But I Am Not Going to Do It”: The Exogenous Factors Influencing Non-Participation in Medical Assistance in Dying

2021 ◽  
pp. 104973232110271
Author(s):  
Janine Brown ◽  
Donna Goodridge ◽  
Lilian Thorpe ◽  
Alexander Crizzle
Keyword(s):  
Nurse Practitioners ◽  
Current Practice ◽  
Social Contact ◽  
Time Factors ◽  
Interpretive Description ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Factors Influencing ◽  
Exogenous Factors ◽  
The Impact

Medical assistance in dying (MAID) processes are complex, shaped by legislated directives, and influenced by the discourse regarding its emergence as an end-of-life care option. Physicians and nurse practitioners (NPs) are essential in determining the patient’s eligibility and conducting MAID provisions. This research explored the exogenous factors influencing physicians’ and NPs’ non-participation in formal MAID processes. Using an interpretive description methodology, we interviewed 17 physicians and 18 NPs in Saskatchewan, Canada, who identified as non-participators in MAID. The non-participation factors were related to (a) the health care system they work within, (b) the communities where they live, (c) their current practice context, (d) how their participation choices were visible to others, (e) the risks of participation to themselves and others, (f) time factors, (g) the impact of participation on the patient’s family, and (h) patient–HCP relationship, and contextual factors. Practice considerations to support the evolving social contact of care were identified.

scholarly journals Information Overload in Emergency Medicine Physicians: A Multisite Case Study Exploring the Causes, Impact, and Solutions in Four North England National Health Service Trusts (Preprint)

2020 ◽  
Author(s):  
Laura Sbaffi ◽  
James Walton ◽  
John Blenkinsopp ◽  
Graham Walton
Keyword(s):  
Emergency Medicine ◽  
National Health Service ◽  
Health Service ◽  
Patient Care ◽  
National Health ◽  
Medical Information ◽  
Information Overload ◽  
Group Analysis ◽  
Emergency Physicians ◽  
The Impact

BACKGROUND Information overload is affecting modern society now more than ever because of the wide and increasing distribution of digital technologies. Social media, emails, and online communications among others infuse a sense of urgency as information must be read, produced, and exchanged almost instantaneously. Emergency medicine is a medical specialty that is particularly affected by information overload with consequences on patient care that are difficult to quantify and address. Understanding the current causes of medical information overload, their impact on patient care, and strategies to handle the inflow of constant information is crucial to alleviating stress and anxiety that is already crippling the profession. OBJECTIVE This study aims to identify and evaluate the main causes and sources of medical information overload, as experienced by emergency medicine physicians in selected National Health Service (NHS) trusts in the United Kingdom. METHODS This study used a quantitative, survey-based data collection approach including close- and open-ended questions. A web-based survey was distributed to emergency physicians to assess the impact of medical information overload on their jobs. In total, 101 valid responses were collected from 4 NHS trusts in north England. Descriptive statistics, principal component analysis, independent sample two-tailed <i>t</i> tests, and one-way between-group analysis of variance with post hoc tests were performed on the data. Open-ended questions were analyzed using thematic analysis to identify key topics. RESULTS The vast majority of respondents agreed that information overload is a serious issue in emergency medicine, and it increases with time. The always available culture (mean 5.40, SD 1.56), email handling (mean 4.86, SD 1.80), and multidisciplinary communications (mean 4.51, SD 1.61) are the 3 main reasons leading to information overload. Due to this, emergency physicians experience guideline fatigue, stress and tension, longer working hours, and impaired decision making, among other issues. Aspects of information overload are also reported to have different impacts on physicians depending on demographic factors such as age, years spent in emergency medicine, and level of employment. CONCLUSIONS There is a serious concern regarding information overload in emergency medicine. Participants identified a considerable number of daily causes affecting their job, particularly the traditional culture of emergency departments being always available on the ward, exacerbated by email and other forms of communication necessary to maintain optimal, evidence-based practice standards. However, not all information is unwelcome, as physicians also need to stay updated with the latest guidelines on conditions and treatment, and communicate with larger medical teams to provide quality care.

Voluntarily Stopping Eating and Drinking

2021 ◽  
Keyword(s):  
Terminal Illness ◽  
Patient Choice ◽  
Medical Assistance ◽  
Severe Dementia ◽  
Caregiver Support ◽  
Medical Assistance In Dying ◽  
Pragmatic Analysis ◽  
Decision Making Capacity ◽  
Wide Range ◽  
Life Options

Voluntary stopping eating and drinking (VSED), though relatively unknown and poorly understood, is a widely available option for hastening death. VSED is legally permitted in places where medical assistance in dying (MAID) is not, and unlike U.S. jurisdictions where MAID is legally permitted, VSED is not limited to terminal illness or to those with current decision-making capacity. With adequate clinician and caregiver support, VSED is a compassionate option that respects patient choice. Moreover, the practice is not limited to avoiding unbearable suffering, but may also be used by those who are determined not to live long with unacceptable deterioration such as severe dementia. Despite the misleading image of “starvation,” death by VSED can typically be peaceful and meaningful when accompanied by adequate clinician/caregiver support. VSED is, however, “not for everyone,” and this volume provides a realistic, appropriately critical as well as supportive assessment of the practice. Eight illustrative, previously unpublished real cases are included, receiving pragmatic analysis in each chapter. The volume’s integrated, multi-professional, multidisciplinary character makes it useful for a wide range of readers: patients considering end-of-life options and their families, clinicians of all kinds, ethicists, lawyers, and institutional administrators. Appendices include recommended elements of an advance directive for stopping eating and drinking and what to record as cause of death on the death certificates for those who hasten death by VSED.

scholarly journals P066: Comfort of emergency medicine physicians in implementing early goal directed therapy for sepsis

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S100-S101
Author(s):  
J. Kaicker ◽  
A. Pardhan ◽  
S. Upadhye ◽  
A. Healey ◽  
T.M. Chan
Keyword(s):  
Emergency Medicine ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Serum Lactate ◽  
Training Data ◽  
Full Time ◽  
Emergency Physicians ◽  
Respiratory Compromise ◽  
Accurate Identification ◽  
Electronic Survey

Introduction: The recently published ProMISe, ARISE and ProCESS trials demonstrated that protocol-based resuscitation (EGDT) of ER patients in whom septic shock was diagnosed did not improve outcome when compared to usual care. The objective of this project was to survey McMaster emergency physicians in areas including sepsis definition, clinical recognition in adults, self-rated skills assessment, attitudes towards skills augmentation and compare results to the cohort surveyed 11 years ago, close to the introduction of EGDT. Methods: Full time faculty at McMaster’s Department of Emergency Medicine and ER residents were surveyed anonymously using an electronic survey. The questions covered demographics and training data, identification of septic patients, sepsis intervention and attitudes towards skills augmentation. Results: A total of 18 physicians responded to the electronic survey to date. All respondents were able to correctly input definitions for SIRS, sepsis, severe sepsis and septic shock. The majority of respondents felt the best strategy to identify potentially septic adults involved monitoring abnormal vital signs (67%) with some stating serum lactate assessment (33%). Of the 11 possible interventions options provided to care for septic patients, respondents appeared more comfortable with placement of lines, giving vasopressors and appropriate use of fluids for resuscitation. This was compared to more specialized interventions like initiating IV steroids in vasopressor dependant shock despite adequate fluid loading. 22% of respondents believed that patients without respiratory compromise with clinically severe sepsis should be intubated which was found to be 48% in the previous cohort surveyed 11 years ago. 78% believed patients in septic shock without respiratory comprise should be intubated, reassuringly similar to the previous survey result of 87%. Conclusion: Emergency physicians at our Canadian institution are comfortable with the skill set required to care for patients with sepsis. Respondents surveyed to date were all comfortable with important resuscitative measures including accurate identification, placement of lines and appropriate fluid administration and were receptive to additional training. Our study emphasizes that our physicians have the skill set to identify and provide care for sepsis using their clinical judgment in cases that may not require protocolized based care.

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