Still safe; still respectful: a mixed methods study exploring the early experiences of a rural community hospice in providing voluntary assisted dying

Abstract

Background Voluntary assisted dying has become available as an end-of-life choice in many countries, including Australia. There is evidence on the mixed impact of voluntary assisted dying legislation on palliative care healthcare professionals, however, less is known about the interface between palliative care and voluntary assisted dying in smaller rural settings. This study explored the experiences of staff at a hospice in rural Western Australia in the two years following the implementation of voluntary assisted dying legislation. Methods A mixed-methods research methodology was used, with data collected via a brief anonymous survey and semi-structured interviews conducted with hospice staff in one rural location in Western Australia. Survey data was exported into SPSS and descriptive statistics were performed. Interviews were audio recorded and after deidentification, the transcripts were analysed thematically. Results A total of 30 participants took part in the survey and 10 were interviewed. The majority (n = 19) of survey respondents had been involved in voluntary assisted dying, yet only seven reported that their day-to-day role had changed. Supporting patient choice and autonomy were the most cited benefits of the introduction of voluntary assisted dying. Analysis of the qualitative data yielded three main themes: everyone is involved with patients accessing VAD; nothing changes but everything changes; and perceived support, education and training needs. Conclusions This study has described day-to-day work and experiences of those working in a small rural hospice which has integrated VAD into the care offered within the facility, observing there are subtle changes in the organisational atmosphere when VAD occurs. The education and support activities in place and the noted gaps may be a useful checklist for other hospices in the early phases of integrating VAD into their facility. Recommendations for future research are made.