School of Nursing, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada.
Northern Medical Program, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, Canada.
BMC Palliat Care. 2021 Apr 12;20(1):55. doi: 10.1186/s12904-021-00740-3.
Rapid implementation of Medical Assistance in Dying (MAiD) across care settings has challenged providers and organizations, including hospices, to develop and implement new modes of practice. The aim of this study was to examine the effects that legalization of MAiD has had on hospice care provider roles within the non-provider context.
Eight in-depth semi-structured interviews were conducted and a qualitative descriptive approach used to examine hospice care providers experiences in a small western Canadian city. In the study context, patients who choose MAiD are cared for until immediately prior to the procedure when they are transferred off-site to undergo MAiD. Inductive and thematic analyses were undertaken.
Participants experienced practical, philosophical, and professional challenges. Despite the overwhelming desire to support patient autonomy and decision-making, some interpreted patient choice for MAiD as rejection of the natural death experience at the hospice. Patient choice for MAiD initiated a new and different pathway of end-of-life care. While participants felt uncertain how best to support patients undergoing MAiD, they shared mixed optimism on how their care provider roles were evolving as their level of experience broadened. While implementation of MAiD was rapid, the introduction of practical and professional supports has remained slow to materialize, leaving many providers to navigate their own personal and professional positions and practices.
Care providers require a multi-faceted range of clinical, legal, and logistical supports at the practice, organizational, and health system levels, to facilitate care delivery to those requesting and undergoing MAiD and to promote coordinated and holistic patient-centered care. The different pathway for those who chose MAiD may lead care providers to struggle with relational challenges and interpersonal unease. Further research may address how to support those undergoing MAiD within the hospice context.
在医疗协助死亡（MAiD）在各个医疗环境中的快速实施，对医疗服务提供者和组织（包括临终关怀机构）提出了挑战，需要他们开发和实施新的实践模式。本研究的目的是探讨 MAiD 合法化对非提供者背景下临终关怀服务提供者角色的影响。
在加拿大西部一个小城市，对 8 名临终关怀服务提供者进行了深入的半结构化访谈，并采用定性描述方法来研究他们的经验。在研究背景下，选择 MAiD 的患者在接受 MAiD 前会在临终关怀机构接受护理，直到他们被转移到现场外进行 MAiD 手术。采用归纳和主题分析。
参与者面临实际、哲学和专业方面的挑战。尽管大多数人强烈希望支持患者的自主权和决策，但有些人将患者选择 MAiD 解释为对临终关怀机构自然死亡体验的拒绝。患者选择 MAiD 启动了一个新的、不同的临终关怀路径。尽管参与者对如何最好地支持正在接受 MAiD 的患者感到不确定，但他们对自己的护理提供者角色如何随着经验的增加而演变持混合的乐观态度。虽然 MAiD 的实施很快，但实际和专业支持的引入仍然缓慢，这使得许多提供者不得不自行探索自己的个人和专业立场和实践。
在实践、组织和卫生系统层面上，护理提供者需要多方面的临床、法律和后勤支持，以促进向请求和正在接受 MAiD 的患者提供护理，并促进协调和整体的以患者为中心的护理。对于选择 MAiD 的患者的不同路径可能导致护理提供者在人际关系方面面临挑战和不适。进一步的研究可以探讨如何在临终关怀环境中支持那些正在接受 MAiD 的患者。
