Bérubé A, Tapp D, Dupéré S, Plaisance A, Bravo G, Downar J, Couture V
Faculty of Nursing, Laval University, Pavillon Ferdinand-Vandry, local A-3645-D, Quebec City, QC, Canada.
Cardiology Department, Quebec Heart and Lung Institute Research Center-Laval University, Quebec City, QC, Canada.
J Palliat Care. 2025 Apr;40(2):152-161. doi: 10.1177/08258597221131658. Epub 2022 Oct 13.
ObjectiveAccess to palliative and end-of-life (EOL) care might be influenced by knowledge, attitudes, and representations of these practices. Socioeconomic factors might then affect what people know about EOL care practices, and how they perceive them. This study aims to compare knowledge, attitudes, and representations regarding EOL practices including assisted suicide, medical assistance in dying, and continuous palliative sedation of adults, according to socioeconomic variables.MethodsA cross-sectional community-based questionnaire study featuring two evolving vignettes and five end-of-life practices was conducted in Quebec, Canada. Three sample subgroups were created according to the participants' perceived financial situation and three according to educational attainment. Descriptive analysis was used to compare levels of knowledge, attitudes, and representations between the subgroups.ResultsNine hundred sixty-six (966) people completed the questionnaire. Two hundred and seventy participants (28.7%) had a high school diploma or less, and 42 participants (4.4%) were facing financial hardship. The majority of respondents supported all end-of-life options and the loosening of eligibility requirements for medical assistance in dying. Differences between subgroups were minor. While respondents in socioeconomically disadvantaged subgroups had less knowledge about EOL practices, those with lower educational attainment were more likely to be in favor of medical assistance in dying, and less likely to favor continuous palliative sedation.ConclusionsPeople living with situational social and economic vulnerabilities face multiple barriers in accessing health care. While they may have poorer knowledge about EOL practices, they have a positive attitude towards medical assistance in dying and assisted suicide, and a negative attitude towards continuous palliative sedation. This highlights the need for future research and interventions aimed at empowering this population and enhancing their access to EOL care.
目的
姑息治疗和临终关怀的可及性可能会受到对这些医疗行为的认知、态度及观念的影响。社会经济因素可能进而影响人们对临终关怀医疗行为的了解程度以及他们对这些行为的认知。本研究旨在根据社会经济变量，比较成年人对包括协助自杀、临终医疗协助及持续姑息性镇静在内的临终医疗行为的认知、态度及观念。
方法
在加拿大魁北克省开展了一项基于社区的横断面问卷调查研究，该研究采用了两个不断演变的案例及五种临终医疗行为。根据参与者自我感知的财务状况创建了三个样本亚组，并根据教育程度创建了另外三个亚组。采用描述性分析来比较各亚组之间的认知、态度及观念水平。
结果
966人完成了问卷调查。270名参与者（28.7%）拥有高中文凭或更低学历，42名参与者（4.4%）面临经济困难。大多数受访者支持所有临终选择以及放宽临终医疗协助的资格要求。亚组之间的差异较小。虽然社会经济处于不利地位的亚组中的受访者对临终医疗行为的了解较少，但教育程度较低的受访者更倾向于支持临终医疗协助，而不太支持持续姑息性镇静。
结论
面临社会和经济困境之人在获得医疗保健方面面临多重障碍。虽然他们对临终医疗行为的了解可能较少，但他们对临终医疗协助和协助自杀持积极态度，而对持续姑息性镇静持消极态度。这凸显了未来开展研究和干预措施的必要性，旨在增强这一人群的能力并改善他们获得临终关怀的机会。
