Implementation of Medical Assistance in Dying: An evaluation of clinician knowledge and perceptions at a large urban multi-site rehabilitation centre in Toronto

Abstract

Objective: Evaluate clinician knowledge and perceptions to ensure the newly implemented Medical Assistance in Dying (MAID) policies and guidelines are understood correctly to help facilitate the best possible experience for patients and their families. Methods: One hundred and twenty-five clinicians completed a survey, developed for this study, to determine their perceptions and knowledge base related to MAID. Results: The average grade on the knowledge-based portion of the survey was 69%. On average, respondents displayed a good understanding (84%) of the legislated eligibility criteria while room for improvement was noted for facility specific policy questions (65%) and general principle questions (71%). Analysis of perception-based questions indicated most respondents were in support of MAID, however, they expressed mixed feelings towards the ease of having MAID related conversations. Respondents expressed mixed opinions in relation to whether the facility was providing adequate training to staff. Sixty-four percent of respondents expressed interest in receiving further training relating to MAID. Conclusions: Education for healthcare providers to ensure they understand the relevant hospital policy and guidelines is critical to improve compliance with the implementation of MAID. It is important to continue to understand and support the perceptions of clinicians to ensure that MAID is administered correctly and as effectively as possible.

Maid in Canada: Controversies, guidelines, and the role of psychologists in relation to Bill C-14.

“…Physicians and nurses from across Canada have shared that they do not have adequate educational or psychosocial resources for MAID, including how to respond to the grief of family members after MAID and how to cope with their own grief (Antonacci et al, 2019; Hogg et al, 2018). The literature on the impacts of participating in PAD demonstrates profound differences in experience.…”

Development of Voluntary Assisted Dying Training in Victoria, Australia: A Model for Consideration

“…The Ministerial Advisory Panel noted it provides assurance to the community that assessments will be undertaken consistently, and also provides participating doctors with certainty that they are appropriately interpreting the legal framework. 6 We note that in other jurisdictions, knowledge of VAD laws has been identified as a challenge 9,21 with calls for more professional education. 9,21,22 Indeed, this is consistent with findings about deficits in legal knowledge in other areas of end-of-life law.…”

“…6 We note that in other jurisdictions, knowledge of VAD laws has been identified as a challenge 9,21 with calls for more professional education. 9,21,22 Indeed, this is consistent with findings about deficits in legal knowledge in other areas of end-of-life law. [23][24][25] A mandated and standardized training program can ensure baseline knowledge of the VAD laws.…”

“…3,7 In Canada, Ball et al report in relation to the provincial medical college’s effective referral policy that “[p]hysician misinformation and misunderstandings have led to patients being misinformed about location options, process and even procedure eligibility.” 8 Hogg et al surveyed Canadian health practitioners and identified gaps in their knowledge of the law, with a majority (64%) of respondents expressing interest in further training. 9 A lack of knowledge about the law not only affects patients, but can leave doctors and health practitioners feeling unprepared to manage conversations about VAD. 9 Surveys on the attitudes of Australian and New Zealand geriatricians, 10 and Australian medical oncologists 11 on the legalization of VAD also emphasized doctors’ desire for greater certainty about the boundaries of eligibility criteria.…”

The factors that act as barriers and enablers to the implementation of voluntary assisted dying services in acute care health settings: a systematic mixed studies review and secondary analysis

“…[11][12][13] While previous reviews have explored healthcare providers' experiences consideration must also be given to the intensity of required resources and education of those involved in VAD, to more fully guide health service managers and others responsible for implementing VAD. [14][15][16][17] Through a systematic review of this research literature, followed by a secondary analysis using a theoretical implementation framework, insights into potential factors that may act as barriers and enablers to VAD practice may be identified, and strategies to support implementation recommended.…”