Marcoux Isabelle, Boivin Antoine, Mesana Laura, Graham Ian D, Hébert Paul
Interdisciplinary School of Health Sciences, Faculty of Health Sciences (Marcoux, Mesana) and School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine (Graham), University of Ottawa, Ottawa, Ont.; Department of Family Medicine, Faculty of Medicine (Boivin), University of Montreal Hospital Research Centre, Montréal, Que.; Centre de recherche du centre hospitalier de l'Université de Montréal (Hébert), Montréal, Que.
CMAJ Open. 2016 May 5;4(2):E222-9. doi: 10.9778/cmajo.20150084. eCollection 2016 Apr-Jun.
Medical end-of-life practices are hotly debated in Canada, and data from other countries are used to support arguments. The objective of this pilot study was twofold: to adapt and validate a questionnaire designed to measure the prevalence of these practices in Canada and the underlying decision-making process, and to assess the feasibility of a nationally representative study.
In phase 1, questionnaires from previous studies were adapted to the Canadian context through consultations with a multidisciplinary committee and based on a scoping review. The modified questionnaire was validated through cognitive interviews with 14 physicians from medical specialties associated with a higher probability of being involved with dying patients recruited by means of snowball sampling. In phase 2, we selected a stratified random sample of 300 Canadian physicians in active practice from a national medical directory and used the modified tailored method design for mail and Web surveys. There were 4 criteria for success: modified questions are clearly understood; response patterns for sensitive questions are similar to those for other questions; respondents are comparable to the overall sampling frame; and mean questionnaire completion time is less than 20 minutes.
Phase 1: main modifications to the questionnaire were related to documentation of all other medical practices (including practices intended to prolong life) and a question on the proportionality of drugs used. The final questionnaire contained 45 questions in a booklet style. Phase 2: of the 280 physicians with valid addresses, 87 (31.1%) returned the questionnaire; 11 of the 87 declined to participate, for a response rate of 27.1% (n = 76). Most respondents (64 [84%]) completed the mail questionnaire. All the criteria for success were met.
It is feasible to study medical end-of-life practices, even for practices that are currently illegal, including the intentional use of lethal drugs. Results from this pilot study support conducting a large national study, but additional strategies would be necessary to improve the response rate.
加拿大对于医疗临终实践存在激烈争论，且常引用其他国家的数据来支持相关论点。本试点研究有两个目标：一是对一份旨在衡量加拿大这些实践的普遍性及潜在决策过程的问卷进行改编和验证，二是评估一项具有全国代表性研究的可行性。
在第一阶段，通过与一个多学科委员会协商并基于范围界定综述，将先前研究中的问卷改编以适应加拿大国情。经对通过雪球抽样招募的、来自与临终患者接触可能性较高的医学专科的14名医生进行认知访谈，对修改后的问卷进行了验证。在第二阶段，我们从全国医疗名录中选取了300名仍在执业的加拿大医生组成分层随机样本，并采用修改后的定制方法设计邮件和网络调查。成功有4项标准：修改后的问题易于理解；敏感问题的回答模式与其他问题相似；受访者与总体抽样框架具有可比性；问卷平均完成时间少于20分钟。
第一阶段：问卷的主要修改涉及所有其他医疗实践（包括旨在延长生命的实践）的记录以及一个关于所用药物比例的问题。最终问卷以小册子形式包含45个问题。第二阶段：在280名有有效地址的医生中，87名（31.1%）返回了问卷；87名中有11名拒绝参与，回复率为27.1%（n = 76）。大多数受访者（64名[84%]）完成了邮件问卷。所有成功标准均得到满足。
研究医疗临终实践是可行的，即使是对于目前非法的实践，包括故意使用致命药物。本试点研究的结果支持开展一项大规模的全国性研究，但需要采取额外策略来提高回复率。
