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.

Awe, consumer conformity and social connectedness

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Yan Yang ◽  
Jing Hu ◽  
Bang Nguyen
Keyword(s):  
Social Connectedness ◽  
Online Survey ◽  
Decision Makers ◽  
Survey Study ◽  
Consumer Decision Making ◽  
Content Type ◽  
Mediating Role ◽  
Effective Policy ◽  
Choice Tasks

PurposeThe purpose of this paper is to explore the effect of the feeling awe on individuals' endorsement of conformist attitudes in consumption choices and the mediating role of social connectedness in generating this effect.Design/methodology/approachWe test our hypotheses across three studies. Study 1 used an online survey. Study 2 and 3 conducted two laboratory experiments to induce awe and measured consumer conformity in two consumption choice tasks.FindingsThis research shows that both dispositional awe and induced awe can increase individuals' preferences for majority-endorsed vs. minority-endorsed choice alternatives in subsequently unrelated consumption situations, and this effect is mediated by perceptions of social connectedness with other decision-makers.Practical implicationsMarketers can promote the sales of mass-market products through inducing awe.Social implicationsPublic regulators could utilize people's incidental awe as an effective policy intervention to nudge individual cooperation in some cases.Originality/valueThe research is the first to demonstrate a novel consequence of awe on consumer decision-making. It also highlights the significance of desire for social connectedness that explains why the feeling of awe develops conformity to the opinions of unknown people.

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.  

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 A National Survey of Canadian Psychiatrists’ Attitudes toward Medical Assistance in Death

2017 ◽  
Vol 62 (11) ◽  
pp. 787-794 ◽  
Author(s):  
Skye Rousseau ◽  
Sarah Turner ◽  
Harvey Max Chochinov ◽  
Murray W. Enns ◽  
Jitender Sareen
Keyword(s):  
Mental Illness ◽  
Online Survey ◽  
Response Rate ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Medical Assistance ◽  
Cross Sectional ◽  
Medical Assistance In Dying ◽  
Psychological Suffering ◽  
Vulnerable Patients

Background: Bill C-14 allows for medical assistance in dying (MAID) for patients who have intolerable physical or psychological suffering that occurs in the context of a reasonably foreseeable death. In Canada, psychiatrist support for MAID on the basis of mental illness and beliefs influencing level of support are unknown. The objectives of this research were to 1) determine if psychiatrists are supportive of MAID under certain conditions and on the basis of mental illness and 2) determine what factors are related to psychiatrist support for MAID on the basis of mental illness. Methods: This cross-sectional study was conducted among 528 psychiatrists in Canada using an online survey platform (February 19 to March 11, 2016). Results: The response rate was 20.9% ( n = 528). Most psychiatrists supported the legalisation of MAID in some circumstances (72%); however, only 29.4% supported MAID on the basis of mental illness. Factors correlating with decreased support for MAID for mental illness were the belief that MAID for mental illness would change the psychiatrists’ commitment to their patients through enduring suffering, having a personal faith, and having had past patients who would have received MAID for mental illness were it legal but instead went on to recover. Interpretation: This study found that most psychiatrists do not support the legalisation of MAID for mental illness, despite being quite supportive of MAID in general. Objections seemed to be based upon concern for vulnerable patients, personal moral objections, and concern for the effect it would have on the therapeutic alliance.

Lack of Standardization in Determination of Intracranial Pressure

2020 ◽  
Vol 14 (1) ◽  
pp. 19-28
Author(s):  
Christopher Minor ◽  
Johanna Tovar-Segura ◽  
Folefac D. Atem ◽  
Sonja E. Stutzman ◽  
Anupama Manjunath ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Nurse Practitioners ◽  
Online Survey ◽  
Predictor Variable ◽  
Survey Study ◽  
International Perspectives ◽  
Significant Difference ◽  
Attending Physicians ◽  
Treatment And Diagnosis

BackgroundIntracranial pressure (ICP) values guide treatment and diagnosis in the ICU. Lack of agreement on ICP determination reduces the validity of ICP as a predictor variable in research and clinical practice. This study explores international perspectives of interpreting an ICP tracing to document an ICP value across varying lengths of time.MethodsThis was a prospective anonymous online survey study of clinician practice of ICP measurement using patient data showing an ICP trend. Participants were shown one of three scenarios at 1-minute, 3-minute, and 5-minute ICP trends. It wasn't possible to randomized participants, however multiple reading improves precision. Paired t-test was used to explore for differences within each scenario and between each epoch.ResultsThere were a total of 332 international responses which came from 247 nurses, 43 attending physicians, 29 nurse practitioners, and 12 physicians in training. Estimates of ICP were significantly different for two of the three scenarios (p < .0001). The range of ICP values was largest during the 3-minute epoch (from 5 to 40 mmHg).ConclusionsThere is a wide and inconsistent variation in the determination of ICP with significant difference between for two of the three scenarios. Without a standardized amount of time to provide to clinicians, variability in ICP reporting will continue.

Feeling Threatened by Immigrants: The Role of Ideology and Subjective Societal Status

2020 ◽  
Author(s):  
Michael Bollwerk ◽  
Bernd Schlipphak ◽  
Joscha Stecker ◽  
Jens Hellmann ◽  
Gerald Echterhoff ◽  
...  
Keyword(s):  
Online Survey ◽  
Middle Eastern ◽  
Social Dominance Orientation ◽  
Survey Study ◽  
Future Research ◽  
Right Wing Authoritarianism ◽  
Threat Perceptions ◽  
Contextual Determinants ◽  
Intergroup Conflicts ◽  
And Gender

Threat perceptions towards immigrants continue to gain importance in the context of growing international migration. To reduce associated intergroup conflicts, it is crucial to understand the personal and contextual determinants of perceived threat. In a large online survey study (N = 1,184), we investigated the effects of ideology (i.e., Right-Wing Authoritarianism and Social Dominance Orientation), subjective societal status (SSS) and their interaction effects in predicting symbolic and realistic threat perceptions towards Middle Eastern immigrants. Results showed that ideology (higher RWA and SDO) and lower SSS significantly predicted both symbolic and realistic threat, even after controlling for income, education, age, and gender. Furthermore, ideology and SSS interacted significantly in predicting realistic threat, with higher levels of SDO and RWA enhancing the effect of SSS. In the discussion, we focus on the implications of our findings with respect to understanding societal conflicts, discuss methodological limitations, and provide directions for future research.

Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study (Preprint)

2020 ◽  
Author(s):  
Khanh Ngoc Cong Duong ◽  
Tien Nguyen Le Bao ◽  
Phuong Thi Lan Nguyen ◽  
Thanh Vo Van ◽  
Toi Phung Lam ◽  
...  
Keyword(s):  
Psychological Distress ◽  
General Population ◽  
Psychological Health ◽  
Online Survey ◽  
Survey Study ◽  
Limited Information ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Event Scale ◽  
The Impact

BACKGROUND The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public. OBJECTIVE This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam. METHODS We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis. RESULTS A total of 1385 respondents completed the survey. Of this, 35.9% (n=497) experienced psychological distress, as well as depression (n=325, 23.5%), anxiety (n=195, 14.1%), and stress (n=309, 22.3%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95% CI 4.49 to 7.21), anxiety (B=3.64, 95% CI 2.64 to 4.63), and stress (B=5.19, 95% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95% CI 4.54 to 14.59), anxiety (B=7.24, 95% CI 3.55 to 10.9), and stress (B=10.60, 95% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95% CI 1.68 to 5.01) and stress (B=2.34, 95% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5%) expressed concern for their children aged &lt;18 years, which increased their IES-R score (B=7.81, 95% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4%) were confident about their doctor’s expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=–7.84, 95% CI –14.58 to –1.11). CONCLUSIONS The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts. CLINICALTRIAL

Understanding Teens’ Perceptions and Aspirations towards Relationship with Personal Technology: Survey Study (Preprint)

2020 ◽  
Author(s):  
Muhammad Jee ◽  
Alsa Khan
Keyword(s):  
Online Survey ◽  
Design Thinking ◽  
Survey Study ◽  
User Experience Design ◽  
Personal Connection ◽  
New Associations ◽  
Future Technology ◽  
Use Of Technology ◽  
Personal Technology ◽  
Age Range

BACKGROUND Understanding teens' relationship with technology is a pressing topic in this digital era. There seem to be both benefit and harmful implications that originate from use of technology by teens. Approximately 95% of teenagers have access to a smartphone, and several studies show a positive correlation between screen addiction and trends of Anxiety and Depression. While, at the same time, research shows that two-thirds of teenagers believe that technology is a necessity for connecting and making new friends. OBJECTIVE The aim of this research is to understand teens’ perceptions of their own and others’ relationship with personal technology and what future relationships do teens aspire to have with their technology. This will be fundamental in helping designers, healthcare practitioners and youth counselors inform design in technology accordingly. METHODS This research paper explores teens and technology relationship via three lenses. Lens-1 is teens' perception of their current relationship with their personal technology as users. Lens-2 is teens' perception of others' (parents, siblings or friends) relationship with personal technology as bystanders. Lens-3 is teens’ aspiration of how they wish to relate to their personal technology. We conducted an online survey with 619 teens in the 13-19 years age range. RESULTS We found that teens selected 'Essential,' 'Distractive,' and 'Addictive' most commonly to describe their own and others' relationship with personal technology. Whereas teens selected 'Provides an escape' more to describe their own relationship with technology. In contrast, they selected 'It's just a tool' and 'Creates Barrier' more to describe others' relationship with technology. These trends are consistent across ages and genders. Additionally, we found that 13-15 year-olds, particularly the majority of females in this age range, wish to see their future technology as their 'best friend.' However, 16-17 year-olds’ top choice was 'I don't believe in personal connection with mobile technology,’ and 18-19 year-olds’ top choice was 'My personal assistant.’ CONCLUSIONS Our three lenses approach is holistic as it allowed comparison of how teens perceive their relationship with personal technology as users vs. bystanders and from current vs. aspirational perspectives. This research not just confirms what is already known, but uncovers critical new associations more exclusive to teens' own relationship with technology. This paper presents related design implications to inform personal tech design thinking, including our guideline to shift 'user experience design' process to 'user relationship design.'

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

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e043547
Author(s):  
Donald A Redelmeier ◽  
Kelvin Ng ◽  
Deva Thiruchelvam ◽  
Eldar Shafir
Keyword(s):  
Socioeconomic Status ◽  
Palliative Care ◽  
Low Socioeconomic Status ◽  
Case Control ◽  
Control Analysis ◽  
Medical Assistance ◽  
Low Socioeconomic ◽  
Medical Assistance In Dying ◽  
Income Status ◽  
Economic Constraints

ObjectivesEconomic constraints are a common explanation of why patients with low socioeconomic status tend to experience less access to medical care. We tested whether the decreased care extends to medical assistance in dying in a healthcare system with no direct economic constraints.DesignPopulation-based case–control study of adults who died.SettingOntario, Canada, between 1 June 2016 and 1 June 2019.PatientsPatients receiving palliative care under universal insurance with no user fees.ExposurePatient’s socioeconomic status identified using standardised quintiles.Main outcome measureWhether the patient received medical assistance in dying.ResultsA total of 50 096 palliative care patients died, of whom 920 received medical assistance in dying (cases) and 49 176 did not receive medical assistance in dying (controls). Medical assistance in dying was less frequent for patients with low socioeconomic status (166 of 11 008=1.5%) than for patients with high socioeconomic status (227 of 9277=2.4%). This equalled a 39% decreased odds of receiving medical assistance in dying associated with low socioeconomic status (OR=0.61, 95% CI 0.50 to 0.75, p<0.001). The relative decrease was evident across diverse patient groups and after adjusting for age, sex, home location, malignancy diagnosis, healthcare utilisation and overall frailty. The findings also replicated in a subgroup analysis that matched patients on responsible physician, a sensitivity analysis based on a different socioeconomic measure of low-income status and a confirmation study using a randomised survey design.ConclusionsPatients with low socioeconomic status are less likely to receive medical assistance in dying under universal health insurance. An awareness of this imbalance may help in understanding patient decisions in less extreme clinical settings.

Sign in / Sign up

Export Citation Format

Share Document