Dion Stephanie, Wiebe Ellen, Kelly Michaela
School of Public Health (Dion) and Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK.
School of Public Health (Dion) and Department of Family Practice (Wiebe), University of British Columbia, Vancouver, BC; London School of Hygiene and Tropical Medicine (Kelly), University of London, London, UK
CMAJ Open. 2019 Dec 13;7(4):E721-E729. doi: 10.9778/cmajo.20190111. Print 2019 Oct-Dec.
To facilitate access to medical assistance in dying (MAiD) in British Columbia, telemedicine has been used for eligibility assessments. This research explored the impacts of using telemedicine on quality of care.
This mixed-methods study consisted of data from 3 BC health authorities and semistructured interviews with a patient, support persons, providers and administrators about the use of telemedicine for MAiD eligibility assessment. Interviews were conducted by telephone, video meeting or email between June and November 2018. We analyzed the quantitative data using descriptive statistics. We categorized the qualitative data using the 7 dimensions of the BC Health Quality Matrix and then analyzed them qualitatively with abductive coding.
Twenty-one participants (8 MAiD assessors, 1 patient, 7 support persons of patients and 5 MAiD administrators) were interviewed. Telemedicine for MAiD eligibility assessments was highly acceptable to the support persons and patient and to most assessors and administrators. Assessors expressed challenges with empathy, eye contact, nonverbal communication and missing contextual factors. Participants described which patients were appropriate and which were not. Telemedicine improved access and equity for the patients who received this service. It was perceived as an effective and efficient way to perform eligibility assessments. Concerns were expressed by assessors and administrators, but not by the patient or support persons, about confidentiality. Opinions varied on the requirement for a regulated health care professional to be in physical attendance with the patient to act as a witness.
Quality of care can be achieved with telemedicine for MAiD eligibility assessments for specific situations and patients, and this modality has the potential to expand access to MAiD. Updated clinical and administrative policies are needed to address barriers to telemedicine access and to best support patients and assessors using this technology.
为方便不列颠哥伦比亚省获得医疗协助死亡（MAiD），远程医疗已用于资格评估。本研究探讨了使用远程医疗对医疗质量的影响。
这项混合方法研究包括来自不列颠哥伦比亚省3个卫生当局的数据，以及对一名患者、支持人员、提供者和管理人员就使用远程医疗进行MAiD资格评估的半结构化访谈。访谈于2018年6月至11月通过电话、视频会议或电子邮件进行。我们使用描述性统计分析定量数据。我们使用不列颠哥伦比亚省卫生质量矩阵的7个维度对定性数据进行分类，然后用归纳编码进行定性分析。
采访了21名参与者（8名MAiD评估者、1名患者、7名患者支持人员和5名MAiD管理人员）。支持人员、患者以及大多数评估者和管理人员对使用远程医疗进行MAiD资格评估高度认可。评估者表示在同理心、眼神交流、非语言沟通和缺乏背景因素方面存在挑战。参与者描述了哪些患者适合以及哪些不适合。远程医疗改善了接受该服务患者的可及性和公平性。它被视为进行资格评估的有效且高效的方式。评估者和管理人员对保密性表示担忧，但患者和支持人员没有。对于是否需要有执照的医疗保健专业人员亲自陪同患者作为证人，意见不一。
对于特定情况和患者的MAiD资格评估，使用远程医疗可以实现医疗质量，并且这种方式有可能扩大MAiD的可及性。需要更新临床和管理政策，以解决远程医疗可及性的障碍，并为使用该技术的患者和评估者提供最佳支持。
