Oncologists and medical assistance in dying: Where do we stand?

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 64-64
Author(s):  
Gur Chandhoke ◽  
Gregory Russell Pond ◽  
Oren Hannun Levine ◽  
Simon Oczkowski
Keyword(s):  
End Of Life ◽  
Online Survey ◽  
Therapeutic Option ◽  
P Value ◽  
Willingness To Participate ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Radiation Oncologists ◽  
Canadian Association ◽  
Medical Oncologists

64 Background: With the passage of Bill C-14 in June 2016, medical assistance in dying (MAiD) was formally enacted into Canadian law. Since then, approximately 2,000 patients have died with medical assistance across the country, with cancer being the most common qualifying condition. We aimed to understand the views of oncology providers (OPs) regarding MAiD. Methods: We designed and administered an online survey to Canadian OPs’ to assess experience with MAiD, self-perceived knowledge, willingness to participate, and perception of the role of OPs in introducing MAiD as an end-of-life care option. We used complete sampling via the Canadian Association of Medical Oncologists (CAMO) and the Canadian Association of Radiation Oncologists (CARO) membership email lists. The survey was sent to 366 Radiation Oncologists, and 325 Medical Oncologists. Data was collected from April-June 2018. Results were analyzed using descriptive statistics as well as univariate and multivariate analysis. Results: We received 224 responses (response rate 32.4%). 70% of OPs have been approached by patients requesting MAiD. OPs were confident in their knowledge of the eligibility criteria, and previous exposure to MAiD was associated with confidence in this domain (odds ratio [OR]=3.77, 95% CI=2.05-6.94, p value<0.001). OPs were most willing to engage in MAiD with an assessment for eligibility, yet most refer to specialized teams for assessments. A majority of physicians (52.8%) would initiate a conversation of MAiD with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress. Conclusions: In this first national survey of Canadian OP’s regarding MAiD, we found that most OP’s encounter patient requests for MAiD, are confident in knowledge of eligibility, and are willing to act as assessors of eligibility. Many OP’s believe that it is appropriate to present MAiD as a therapeutic option at the end of life under some circumstances. This finding warrants further deliberation amongst national/regional bodies for the development of consensus guidelines in order to ensure equitable access to MAiD for patients who wish to pursue it.

scholarly journals Oncologists and medical assistance in dying: where do we stand? Results of a national survey of Canadian oncologists

2020 ◽  
Vol 27 (5) ◽  
Author(s):  
G. Chandhoke ◽  
Gregory Pond ◽  
O. Levine ◽  
S. Oczkowski
Keyword(s):  
End Of Life ◽  
National Survey ◽  
Online Survey ◽  
Therapeutic Option ◽  
Willingness To Participate ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Radiation Oncologists ◽  
Canadian Association ◽  
Medical Oncologists

Background In June 2016, when the Parliament of Canada passed Bill C-14, the country joined the small number of jurisdictions that have legalized medical assistance in dying (maid). Since legalization, nearly 7000 Canadians have received maid, most of whom (65%) had an underlying diagnosis of cancer. Although Bill C-14 specifies the need for government oversight and monitoring of maid, the government-collected data to date have tracked patient charac­teristics, rather than clinician encounters and beliefs. We aimed to understand the views of Canadian oncologists 2 years after the legalization of maid. Methods We developed and administered an online survey to medical and radiation oncologists to understand their exposure to maid, self-perceived knowledge, willingness to participate, and perception of the role of oncologists in introducing maid as an end-of-life care option. We used complete sampling through the Canadian Association of Medical Oncologists and the Canadian Association of Radiation Oncology membership e-mail lists. The survey was sent to 691 physicians: 366 radiation oncologists and 325 medical oncologists. Data were collected during March–June 2018. Results are presented using descriptive statistics and univariate or multivariate analysis. Results The survey attracted 224 responses (response rate: 32.4%). Of the responding oncologists, 70% have been approached by patients requesting maid. Oncologists were of mixed confidence in their knowledge of the eligibility criteria. Oncologists were most willing to engage in maid with an assessment for eligibility, and yet most refer to specialized teams for assessments. In terms of introducing maid as an end-of-life option, slight more than half the responding physicians (52.8%) would initiate a conversation about maid with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress. Conclusions In this first national survey of Canadian oncologists about maid, we found that most respondents encounter patient requests for maid, are confident in their knowledge about eligibility, and are willing to act as assessors of eligibility. Many oncologists believe that, under some circumstances, it is appropriate to present maid as a therapeutic option at end of life. That finding warrants further deliberation by national or regional bodies for the development of consensus guidelines to ensure equitable access to maid for patients who wish to pursue it.  

scholarly journals Medical oncology workload in Canada: infrastructure, supports, and delivery of clinical care

2018 ◽  
Vol 25 (3) ◽  
pp. 206 ◽  
Author(s):  
A. Fundytus ◽  
W.M. Hopman ◽  
N. Hammad ◽  
J.J. Biagi ◽  
R. Sullivan ◽  
...  
Keyword(s):  
Online Survey ◽  
Task Force ◽  
Clinical Care ◽  
Median Number ◽  
Models Of Care ◽  
Annual Number ◽  
Canadian Association ◽  
Level Of Activity ◽  
Medical Oncologists ◽  
Number Of Patients

Background In 2000, a Canadian task force recommended that medical oncologists (mos) meet a target of 160–175 new patient consultations per year. Here, we report the Canadian results of a global survey of mo workload compared with mo workload in other high-income countries (hics).Methods Using a snowball method, an online survey was distributed by national oncology societies to chemotherapy-prescribing physicians in 22 hics (World Bank criteria). The survey was distributed within Canada to all members of the Canadian Association of Medical Oncologists. Workload was measured as the annual number of new cancer patient consults per oncologist.Results The survey was completed by 782 oncologists from hics, including 58 from Canada. Median annual consults per mo were 175 in Canada compared with 125 in other hics. The proportions of mos having 100 or fewer consults or more than 300 consults per year were 3% (2/58) and 5% (3/58) in Canada compared with 31% (222/724) and 16% (116/724) in other hics (p < 0.001 and p = 0.023 respectively). The median number of patients seen in a full-day clinic was 15 in Canada and 25 in other hics (p = 0.220). Canadian mos reported spending a median of 55 minutes per new consultation; new consultations of 35 minutes were reported in other hics (p < 0.001). Median hours worked per week was 55 in Canada and 45 in other hics (p = 0.200).Conclusions Although the median annual clinical volume for Canadian mos aligns with recommended targets, half the respondents exceeded that level of activity. Health policymakers and educators have to consider mo workforce supply and alternative models of care in preparation for the anticipated surge in cancer incidence in the coming decade.

scholarly journals Fodder for Despair, Masquerading as Hope: Diagnosing the Postures of Hope(lessness) at the End of Life

Religions ◽  
2019 ◽  
Vol 10 (12) ◽  
pp. 651
Author(s):  
Ashley Moyse
Keyword(s):  
End Of Life ◽  
Human Life ◽  
Medical Professionals ◽  
Human Beings ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Instrumental Reasoning ◽  
Counter Narratives ◽  
Late Modern ◽  
Classical Account

Hope is needed for persons confronting the limits of human life, antagonised by the threats of death. It is needed also for those health and medical professionals constrained by the institution of medicine, determined by market metaphors and instrumental reasoning. Yet, despair can masquerade as hope for such persons when functional hoping for particular outcomes or aims proves futile and aimless. The following will examine such masquerades, while giving attention to particular expressions of autonomy, which persist as fodder for despair in our late modern milieu. The late classical account of Hercules and his death, as well as contemporary reasons for soliciting medical assistance in dying, will focus on the diagnostics of despair, while a Christian account practicing presence, and of hope as a concrete posture enfleshed by habits of patience, among other virtues, will point toward counter-narratives that might sustain persons in times of crisis and enable persons’ flourishing as human beings, even unto death.

Referral Practices of Oncologists to Specialized Palliative Care

2012 ◽  
Vol 30 (35) ◽  
pp. 4380-4386 ◽  
Author(s):  
Kirsten Wentlandt ◽  
Monika K. Krzyzanowska ◽  
Nadia Swami ◽  
Gary M. Rodin ◽  
Lisa W. Le ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Surgical Oncology ◽  
Disease Course ◽  
Radiation Oncologists ◽  
Canadian Association ◽  
Medical Oncologists ◽  
Referral Practices ◽  
Specialized Palliative Care

Purpose To describe current referral practices of oncologists to specialized palliative care (SPC) and define demographic characteristics, practice situations, and opinions associated with referral. Methods Physician members of the Canadian Association of Medical Oncologists, Canadian Association of Radiation Oncologists, and Canadian Society of Surgical Oncology were invited to participate in an anonymous survey assessing SPC referral practices. Participants received two e-mailed and two mailed invitations. Results The response rate was 72% (603 of 839 physicians); 37% were medical oncologists/hematologists, 50% were radiation oncologists, and 12% were surgical oncologists. Ninety-four percent reported that SPC was available to them, but only 37% reported that these services accepted patients on chemotherapy. Eighty-four percent referred terminally ill patients usually/always, but generally for uncontrolled symptoms or discharge planning late in the disease course. One third would refer to SPC earlier if it was renamed supportive care. Predictors of higher referral frequency included comprehensiveness of available SPC services (P = .004), satisfaction with SPC availability (P < .001), SPC acceptance of patients receiving chemotherapy (P < .001), and oncologist ease with referring patients to a palliative care service before they were close to death (P < .001). Controlling for specialty, predictors of referral at diagnosis or during chemotherapy, rather than later, included satisfaction with SPC service availability (P < .001) and SPC service acceptance of patients on chemotherapy (P < .001). Conclusion Oncologists referred patients frequently to SPC, but generally late in the disease course for patients with uncontrolled symptoms. Availability of comprehensive SPC, especially for patients receiving chemotherapy, and persisting definitional issues seem to be the main barriers preventing timely referral.

Nutrition services for men with prostate cancer: A health professional survey.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 25-25
Author(s):  
Kaity McLaughlin ◽  
Lindsay Hedden ◽  
Phil Pollock ◽  
Celestia S. Higano ◽  
Rachel A Murphy
Keyword(s):  
Prostate Cancer ◽  
Health Care Professionals ◽  
Online Survey ◽  
Unmet Need ◽  
Nutrition Support ◽  
Registered Dietitians ◽  
Nutrition Services ◽  
Radiation Oncologists ◽  
Medical Oncologists ◽  
Nutrition Service

25 Background: Nutrition is a key part of prostate cancer (PC) survivorship for management of PC, treatment side effects, and overall health. The Prostate Cancer Supportive Care (PCSC) Program is one of only a few PC survivorship programs in Canada that provide nutrition support as part of standard care. A survey was conducted as part of a broader needs assessment to understand health care professionals’ (HCPs) perspectives on nutrition services for men with PC and inform nutrition programs. Methods: An online survey was administered to British Columbia (BC) HCPs caring for men with PC including urologists, radiation oncologists, medical oncologists, registered dietitians and researchers. We used purposive sampling to identify relevant HCPs. HCPs were asked about the importance of oncological nutrition services and how they should be delivered to men with PC. We summarized the percent agreement for each question and across professions then thematically analyzed qualitative data. Results: Of the 56 HCPs invited to participate in the survey, 38 (68%) responded. The majority (61%) agreed that men with PC require more nutritional support. HCPs indicated nutrition services should be offered multiple times throughout survivorship and facilitated through online resources, individual consultations with registered dietitians and consecutive group education sessions. Most (75%) urologists, radiation oncologists and medical oncologists responded that weight management should be the focus for nutrition services, whereas 90% of dietitians responded that nutrition for reducing the risk of PC progression should be the focus. The main themes that arose from the survey suggested that nutrition services should be available in different forms to facilitate individual needs and adapted based on cultural and community settings. Conclusions: HCPs confirm that there is an unmet need for nutrition services for men with PC in BC as existing services prioritize and offer services for cancer-related weight loss. Special consideration should be given to the focus of nutrition service provided, and when and how it is offered. These results will inform the development of additional resources for men with PC to support their nutritional needs.

scholarly journals How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers

2021 ◽  
Vol 15 ◽  
pp. 263235242110459
Author(s):  
Anita Ho ◽  
Joshua S. Norman ◽  
Soodabeh Joolaee ◽  
Kristie Serota ◽  
Louise Twells ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Assisted Dying ◽  
Life Care ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Qualitative Thematic Analysis

Background: More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying. Understanding how end-of-life care discussions between patients and specialist palliative care providers may be affected by such legislation can inform end-of-life care delivery in the evolving socio-cultural and legal environment. Aim: To explore how the Canadian Medical Assistance in Dying legislation affects end-of-life care discussions between patients and multidisciplinary specialist palliative care providers. Design: Qualitative thematic analysis of semi-structured interviews. Participants: Forty-eight specialist palliative care providers from Vancouver (n = 26) and Toronto ( n = 22) were interviewed in person or by phone. Participants included physicians ( n = 22), nurses ( n = 15), social workers ( n = 7), and allied health professionals ( n = 4). Results: Qualitative thematic analysis identified five notable considerations associated with Medical Assistance in Dying affecting end-of-life care discussions: (1) concerns over having proactive conversations about the desire to hasten death, (2) uncertainties regarding wish-to-die statements, (3) conversation complexities around procedural matters, (4) shifting discussions about suffering and quality of life, and (5) the need and challenges of promoting open-ended discussions. Conclusion: Medical Assistance in Dying challenges end-of-life care discussions and requires education and support for all concerned to enable compassionate health professional communication. It remains essential to address psychosocial and existential suffering in medicine, but also to provide timely palliative care to ensure suffering is addressed before it is deemed irremediable. Hence, clarification is required regarding assisted dying as an intervention of last resort. Furthermore, professional and institutional guidance needs to better support palliative care providers in maintaining their holistic standard of care.

scholarly journals Advance Requests for Medical Assistance in Dying in Dementia: a Survey Study of Dementia Care Specialists

2021 ◽  
Vol 24 (2) ◽  
pp. 82-95
Author(s):  
Allison Nakanishi ◽  
Lauren Cuthbertson ◽  
Jocelyn Chase
Keyword(s):  
Online Survey ◽  
Geriatric Medicine ◽  
Dementia Care ◽  
Decision Makers ◽  
Survey Study ◽  
Medical Assistance ◽  
Progressive Dementia ◽  
Medical Assistance In Dying ◽  
Study Support

Background Current Canadian Medical Assistance in Dying (MAiD) legislation requires individuals to have the mental capacity to consent at the time of the procedure. Advance requests for MAiD (ARs for MAiD) could allow individuals to document conditions where MAiD would be desired in the setting of progressive dementia. Methods Greater Vancouver area dementia care clinicians from family practice, geriatric medicine, geriatric psychiatry, and palliative care were approached to participate in an online survey to as­sess attitudes around the appropriateness of ARs for MAiD. Quantitative analysis of survey questions and qualitative analysis of open-ended response questions were performed. Results Of 630 clinicians approached, 80 were included in the data analysis. 64% of respondents supported legislation allowing ARs for MAiD in dementia. 96% of respondents articulated barriers and concerns, including determination of capacity, protecting the interests of the future individual, navigating conflict among stakeholders, and identifying coercion. 78% of respondents agreed with a mandatory capacity assessment to create an AR, and 59% agreed that consensus between clinicians and substitute decision-makers was required to enact an AR. Conclusion The majority of Vancouver dementia care clinicians participat­ing in this study support legislation allowing ARs for MAiD in dementia, while also articulating ethical and logistical concerns with its application.

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.

The Somatechnologies of Canada's Medical Assistance in Dying Law: LGBTQ Discourses on Suicide and the Injunction to Live

Somatechnics ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 201-217 ◽  
Author(s):  
Alexandre Baril
Keyword(s):  
End Of Life ◽  
Assisted Suicide ◽  
Mental Disability ◽  
Medical Assistance ◽  
Disabled People ◽  
Canadian Government ◽  
Physically Disabled ◽  
Medical Assistance In Dying ◽  
Oppressed Group ◽  
Physically Disabled People

In June 2016, the Canadian government passed Bill C-14 on medical assistance in dying, allowing for medically assisted suicide when ‘death has become reasonably foreseeable.’ While available for ill or physically disabled people at the end-of-life, medically assisted suicide is denied in cases where people are perceived to have a mental disability and whose suffering is strictly emotional/psychological, such as suicidal people. I argue that this distinction results in constructing two classes of suicidal subjects by considering physically disabled or ill people as legitimate subjects who should receive assistance in dying and suicidal people as illegitimate subjects who must be kept alive through what I call the ‘injunction to live’ and ‘somatechnologies of life’. Analysing discourses on suicide targeting lesbian, gay, bisexual, trans* and queer (LGBTQ) people in LGBTQ scholarship, I argue that, based on the silencing of suicidal subjects through the injunction to live, suicidal people constitute an oppressed group whose claims remain unintelligible within society, law, medical/psychiatric systems and LGBTQ scholarship. This article calls for listening to suicidal people's voices and developing an accountable response to their suffering and claims.

Perceptions and Experiences of Medical Assistance in Dying Among Illicit Substance Users and People Living in Poverty

2019 ◽  
pp. 003022281988982
Author(s):  
Jessica Shaw ◽  
Laura Harper ◽  
Emma Preston ◽  
Alysia Wright ◽  
Michaela Kelly ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Best Practice ◽  
Life Care ◽  
Medical Assistance ◽  
Substance Users ◽  
Assisted Death ◽  
Illicit Substance ◽  
Medical Assistance In Dying ◽  
The Difference

Since medical assistance in dying (MAiD) became legal in Canada in 2016, there have been concerns about vulnerable people feeling pressured to end their lives. It is important to understand what people in marginalized communities know and feel about MAiD in order to help prevent any pressure to hasten death and to prevent any barriers to accessing assisted death. This qualitative study explored the perceptions and experiences of MAiD and other end-of-life care options with 46 people who were illicit substance users, living in poverty, or who worked with marginalized people in these communities. Six broad themes were identified: the importance of family, friends, and community; the effects of the opioid crisis; barriers to accessing end-of-life care services; support for MAiD; the difference between suicide and MAiD; and what constitutes a good death. Findings from this research may be used to help inform future legislation, professional guidelines, and standards of best practice.

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