Learning about psychiatric aspects of medical assistance in dying: a pilot survey of self-perceived educational needs among assessors in a Canadian academic hospital

Abstract

Background: Medical assistance in dying (MAiD) was legalized in Canada in 2016, although it has been accessible as an end-of-life option in the province of Quebec since 2015. Before its implementation in clinical settings, few physicians had received formal training on requests assessments. New data indicate MAiD requesters have high rates of psychiatric comorbidities. Hence, assessment and management of psychiatric and psychosocial issues among MAiD requesters are important competencies to develop for assessors, although few training programs address them. The aim of our study was to explore physicians' self-perceived educational needs on psychiatric aspects related to MAiD in the province of Quebec.Methods: We conducted a cross-sectional online survey and used a non-probability sampling design in one academic tertiary care center. A descriptive analysis was performed, and responders were compared on different variables.Results: From twenty-five physician assessors, nineteen responded anonymously to an online survey (n=19).The findings of our pilot study revealed that participants felt highly competent in most psychiatric aspects at end-of-life and related to MAiD practice, except for psychotherapy and psychopharmacology as well as depression identification. Most indicated strong interest in further training. No statistical differences were found among responders regarding previous experience or training in palliative care.Conclusions: Based on our study, MAiD assessors reported high level of competency in managing psychiatric issues among requesters, but that they also expressed a strong desire for additional education.

Improving Palliative Care and Medical Assistance in Dying Practice in Canada: How Patients-Partners Could Contribute to Continuing Medical Education

“… 6 , 15–18 Preliminary data revealed that assessors are interested in further training on psychiatric aspects. 19 Centering MAiD on the patient's needs remains a complex task. 20 …”

The many different languages of assisted suicide

“…The study by Rivest et al must face the possible limitation of selection bias with regard to its small sample size of 19 participants, which might have a favourable opinion towards MAiD (7). However, the response rate of the survey was high and seemed to be representative of an attitude among Canadian physicians that MAiD has become part of medical practice.…”

“…Rivest et al's study results revealed that Canadian physicians reported high levels of competency in managing psychiatric issues among MAiD requesters (7). The authors concluded that this may indicate overconfidence among the participants, as 95% of the participants reported providing EOL care on a regular basis, while 47% had never received any PC or EOL training (7). The authors stated that there is still very little postgraduate training on psychiatric symptoms in PC.…”

“…The study by Rivest et al aimed to explore physicians' selfperceived educational needs regarding the psychiatric aspects related to MAiD in Canada through a cross-sectional online survey in one academic tertiary care centre (7). The survey was completed by 19 physicians from different fields.…”

“…As stated by Rivest et al, there is a lack of training in medical education regarding PC and EOL issues (7). Furthermore, there is a lack of training regarding psychiatric issues and a lack of training regarding psychiatric PC and EOL issues.…”