Assessment of Oncology Advanced Practice Professional Willingness to Participate in Medical Aid in Dying

Abstract

ImportanceIn 2021, New Mexico passed legislation allowing nurse practitioners and physician assistants (referred to herein as advanced practice professionals [APPs]) to prescribe medications for medical aid in dying (MAID). Other US states with existing MAID laws (eg, Washington) are also considering expanding MAID prescribing authority to APPs. There is a lack of research exploring APP knowledge of, willingness to, and comfort with acting as a prescribing or consulting clinician for MAID.ObjectiveTo assess perspectives of oncology APPs regarding MAID, including their willingness to prescribe and/or consult for MAID and factors associated with willingness.Design, Setting, and ParticipantsThis cross-sectional, self-report survey study used data collected from APPs working at a comprehensive cancer center in Washington State in fall 2021.Main Outcomes and MeasuresThe primary survey question was whether APPs would be willing to participate in death with dignity, the term used for MAID in Washington. Survey questions evaluated how influential specific factors were on APP views on MAID as well as respondents’ knowledge of and comfort with aspects of the MAID process.ResultsOf 167 eligible APPs, 77 (46.1%) responded to the survey. Most respondents (68 [88.3%]) reported their race and ethnicity as White; 72 (93.5%) identified as a woman. Medical oncology (28 [36.4%]) was the most common field of practice, and 21 respondents (27.3%) reported having practiced as an APP for 6 to 10 years. Of all respondents, 61 (79.2%) reported having at least 1 patient who inquired about MAID; depending on the question, less than a third of respondents (5.0%-27.0%) endorsed feeling knowledgeable or very knowledgeable about any aspect of the MAID process. In this study, 39 APPs (50.6%) endorsed being willing to participate in MAID either as a consulting or prescribing clinician, whereas 31 (40.3%) were uncertain of whether they would participate. Willingness to participate was associated with having had more patients pursue MAID (33 of the 39 willing participants [84.6%] vs 15 of the 31 unsure participants [48.4%] reported having 1 or more patients pursue MAID). Higher knowledge and comfort scores were both significantly associated with increased odds of being willing to participate (odds ratio, 1.14 per 1-point score increase [95% CI, 1.03-1.27]; P = .01) vs unsure (1.18 [95% CI, 1.07-1.30; P = .001).Conclusions and RelevanceThe results of this survey study suggest that oncology APPs may require preparation for the addition of MAID to their scope of practice. This study also raises questions for future research regarding support for APPs who may be considering participation in MAID but question their role or want physician involvement.

Helping Patients Die: Implementation of a Residency Curriculum in Medical Aid in Dying

“…This lack of MAID-trained clinicians is in clear contrast to the desire for such training among medical students and residents 3–9 . In studies of Canadian trainees, between 41% and 71% reported being willing to provide MAID care 8,9 .…”

“…However, physician training in MAID has been largely inadequate to keep pace with the expansion of MAID legalization. In several studies, clinicians have stated that they were ill-equipped to handle a MAID request from a patient, despite being willing to participate in this type of care 2–4 . Although formal national estimates of access to MAID-trained physicians are still needed, qualitative studies suggest significant access gaps 5 .…”

Medical aid in dying: The role of the nurse practitioner

“…Nurse practitioner participation in medical aid in dying Singer et al (2022) surveyed specialty advanced practice providers (APPs) in Washington state to assess their willingness to participate in MAID. The survey respondents included NPs and PAs who worked mostly in medical oncology, hematology, transplant, and supportive care.…”

“…Of all APPs surveyed, 90.9% either agreed or strongly agreed that MAID should be legal, and the majority agreed that APPs should be included as eligible providers. Regarding their personal participation, 50.6% of respondents reported willingness to participate in MAID, whereas 40.3% were unsure and 9.1% were unwilling to participate (Singer et al, 2022).…”

“…In the United States, physicians were traditionally the only health care providers legally allowed to participate in MAID at the exclusion of other prescribing providers (Stokes, 2017). Recently, the roles and responsibilities of MAID providers have been extended beyond physicians to include nurse practitioners (NPs) and other health care providers (Singer et al, 2022). During this time of continued growth of MAID services, it is important for NPs to understand the current scope of their role and look ahead to anticipate potential implications for NP practice in the future.…”