How can we improve the experiences of patients and families who request medical assistance in dying? A multi-centre qualitative study

• Published in: BMC palliative care 2021-12, Vol.20 (1), p.185-185, Article 185
• Main Authors: Oczkowski, Simon J W, Crawshaw, Diane E, Austin, Peggy, Versluis, Donald, Kalles-Chan, Gaelen, Kekewich, Michael, Curran, Dorothyann, Miller, Paul, Kelly, Michaela, Wiebe, Ellen, Frolic, Andrea
• Format: Article
• Language: English
• Subjects: Assisted suicide; Beliefs, opinions and attitudes; Care and treatment; Clinical medicine; Continuity of care; Demographic aspects; Euthanasia; Family; Hospitals; Interviews; Medical assistance; Medical care; Palliative care; Patient-centered care; Patient-focused research; Patients; Psychological aspects; Qualitative research; Quality management; Quality of care; Suicide, assisted; Suicides & suicide attempts
• ISSN: 1472-684X; 1472-684X
• DOI: 10.1186/s12904-021-00882-4

Medical assistance in dying has been available in Canada for 5 years, but it is unclear which practices contribute to high-quality care. We aimed to describe patient and family perspectives of quality of care for medical assistance in dying. We conducted a multi-centre, qualitative descriptive study, including face to face or virtual one-hour interviews using a semi-structured guide. We interviewed 21 english-speaking patients found eligible for medical assistance in dying and 17 family members at four sites in Canada, between November 2017 and September 2019. Interviews were de-identified, and analyzed in an iterative process of thematic analysis. We identified 18 themes. Sixteen themes were related to a single step in the process of medical assistance in dying (MAID requests, MAID assessments, preparation for dying, death and aftercare). Two themes (coordination and patient-centred care) were theme consistently across multiple steps in the MAID process. From these themes, alongside participant recommendations, we developed clinical practice suggestions which can guide care. Patients and families identified process-specific successes and challenges during the process of medical assistance in dying. Most importantly, they identified the need for care coordination and a patient-centred approach as central to high-quality care. More research is required to characterize which aspects of care most influence patient and family satisfaction.