Strive Health Management Consulting Inc., Halifax, Nova Scotia, Canada.
CareNet Health Management Consulting, Edmonton, Alberta, Canada.
J Palliat Care. 2021 Jul;36(3):157-161. doi: 10.1177/0825859720924169. Epub 2020 May 13.
A challenging issue in contemporary Canadian Medicare is the evolution of end-of-life care. Utilizing data from the 2016 and 2018 Health Care in Canada (HCIC) surveys, this paper compares the support and priorities of the adult public (n = 1500), health professionals (n = 400), and administrators (n = 100) regarding key components for end-of-life care just prior to and post legalization of medical assistance in dying (MAiD) in Canada. In 2016 and 2018, the public, health professionals and administrators strongly supported enhanced availability of all proposed end-of-life care options: pain management, hospice and palliative care, home care supports, and medically assisted death. In 2018, when asked which option should be top priority, the public rated enhanced medically assisted death first (32%), followed by enhanced hospice and palliative care (22%) and home care (21%). Enhanced hospice and palliative care was the top priority for health professionals (33%), while administrators rated enhanced medically assisted death first (26%). Despite legalization and increasing support for MAiD over time, health professionals have increasing fear of legal or regulatory reprisal for personal involvement in medically assisted death, ranging from 38% to 84% in 2018, versus 23% to 42% in 2016. While administrators fear doubled since 2016 (40%-84%), they felt the necessary system supports were in place to easily implement medically assisted death. Optimal management of end-of-life care is strongly supported by all stakeholders, although priorities for specific approaches vary. Over time, professionals increasingly supported MAiD but with a rising fear of legal/regulatory reprisal despite legalization. To enhance future end-of-life care patterns, continued measurement and reporting of implemented treatment options and their system supports, particularly around medically assisted death, are needed.
当代加拿大医疗保险面临的一个挑战是临终关怀的演变。本研究利用 2016 年和 2018 年加拿大卫生保健调查（HCIC）的数据，比较了成年公众（n=1500）、卫生专业人员（n=400）和管理人员（n=100）在加拿大医疗辅助死亡（MAiD）合法化前后对临终关怀关键组成部分的支持和优先事项。2016 年和 2018 年，公众、卫生专业人员和管理人员强烈支持所有拟议的临终关怀选择的可用性增强：疼痛管理、临终关怀和姑息治疗、家庭护理支持以及医疗辅助死亡。2018 年，当被问及哪种选择应作为首要任务时，公众将增强的医疗辅助死亡列为第一（32%），其次是增强的临终关怀和姑息治疗（22%）和家庭护理（21%）。增强的临终关怀和姑息治疗是卫生专业人员的首要任务（33%），而管理人员则将增强的医疗辅助死亡列为第一（26%）。尽管随着时间的推移，MAiD 的合法化和支持率不断提高，但卫生专业人员对个人参与医疗辅助死亡的法律或监管报复的恐惧却在不断增加，2018 年的比例从 2016 年的 38%至 84%不等。2016 年以来，管理人员的恐惧增加了一倍（40%-84%），但他们认为已经有了必要的系统支持来轻松实施医疗辅助死亡。所有利益相关者都强烈支持临终关怀的最佳管理，尽管具体方法的优先级有所不同。随着时间的推移，专业人员越来越支持 MAiD，但尽管已经合法化，但对法律/监管报复的恐惧却在增加。为了改善未来的临终关怀模式，需要继续衡量和报告已实施的治疗选择及其系统支持，特别是在医疗辅助死亡方面。
