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评估肿瘤学高级实践专业人员参与医疗辅助自杀的意愿。

Assessment of Oncology Advanced Practice Professional Willingness to Participate in Medical Aid in Dying.

机构信息

Department of Psychological Sciences, Texas Tech University, Lubbock.

Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.

出版信息

JAMA Netw Open. 2022 Oct 3;5(10):e2239068. doi: 10.1001/jamanetworkopen.2022.39068.


DOI:10.1001/jamanetworkopen.2022.39068
PMID:36287559
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9606841/
Abstract

IMPORTANCE: In 2021, New Mexico passed legislation allowing nurse practitioners and physician assistants (referred to herein as advanced practice professionals [APPs]) to prescribe medications for medical aid in dying (MAID). Other US states with existing MAID laws (eg, Washington) are also considering expanding MAID prescribing authority to APPs. There is a lack of research exploring APP knowledge of, willingness to, and comfort with acting as a prescribing or consulting clinician for MAID. OBJECTIVE: To assess perspectives of oncology APPs regarding MAID, including their willingness to prescribe and/or consult for MAID and factors associated with willingness. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, self-report survey study used data collected from APPs working at a comprehensive cancer center in Washington State in fall 2021. MAIN OUTCOMES AND MEASURES: The primary survey question was whether APPs would be willing to participate in death with dignity, the term used for MAID in Washington. Survey questions evaluated how influential specific factors were on APP views on MAID as well as respondents' knowledge of and comfort with aspects of the MAID process. RESULTS: Of 167 eligible APPs, 77 (46.1%) responded to the survey. Most respondents (68 [88.3%]) reported their race and ethnicity as White; 72 (93.5%) identified as a woman. Medical oncology (28 [36.4%]) was the most common field of practice, and 21 respondents (27.3%) reported having practiced as an APP for 6 to 10 years. Of all respondents, 61 (79.2%) reported having at least 1 patient who inquired about MAID; depending on the question, less than a third of respondents (5.0%-27.0%) endorsed feeling knowledgeable or very knowledgeable about any aspect of the MAID process. In this study, 39 APPs (50.6%) endorsed being willing to participate in MAID either as a consulting or prescribing clinician, whereas 31 (40.3%) were uncertain of whether they would participate. Willingness to participate was associated with having had more patients pursue MAID (33 of the 39 willing participants [84.6%] vs 15 of the 31 unsure participants [48.4%] reported having 1 or more patients pursue MAID). Higher knowledge and comfort scores were both significantly associated with increased odds of being willing to participate (odds ratio, 1.14 per 1-point score increase [95% CI, 1.03-1.27]; P = .01) vs unsure (1.18 [95% CI, 1.07-1.30; P = .001). CONCLUSIONS AND RELEVANCE: The results of this survey study suggest that oncology APPs may require preparation for the addition of MAID to their scope of practice. This study also raises questions for future research regarding support for APPs who may be considering participation in MAID but question their role or want physician involvement.

摘要

重要性:2021 年,新墨西哥州通过立法,允许护士从业者和医师助理(在此称为高级实践专业人员[APP])为医疗辅助自杀(MAID)开处药物。其他拥有现有 MAID 法律的美国州(例如华盛顿)也在考虑将 MAID 处方授权扩大到 APP。缺乏研究探索 APP 对 MAID 的知识、意愿和舒适度,作为 MAID 的处方或咨询临床医生。

目的:评估肿瘤学 APP 对 MAID 的看法,包括他们是否愿意为 MAID 开处方和/或咨询,以及与意愿相关的因素。

设计、地点和参与者:这是一项横断面、自我报告的调查研究,使用了 2021 年秋季在华盛顿州综合癌症中心工作的 APP 收集的数据。

主要结果和措施:主要调查问题是 APP 是否愿意参与尊严死亡,这是华盛顿州 MAID 的术语。调查问题评估了特定因素对 APP 对 MAID 的看法以及受访者对 MAID 过程的知识和舒适度的影响。

结果:在 167 名符合条件的 APP 中,有 77 名(46.1%)对调查做出了回应。大多数受访者(68 [88.3%])报告他们的种族和民族为白人;72 名(93.5%)为女性。肿瘤内科(28 [36.4%])是最常见的实践领域,21 名受访者(27.3%)报告他们作为 APP 的执业时间为 6 至 10 年。在所有受访者中,61 名(79.2%)报告至少有 1 名患者询问过 MAID;根据问题的不同,不到三分之一的受访者(5.0%-27.0%)表示对 MAID 过程的任何方面都有一定程度的了解或非常了解。在这项研究中,39 名 APP(50.6%)表示愿意作为咨询或处方临床医生参与 MAID,而 31 名(40.3%)不确定他们是否会参与。愿意参与与有更多患者寻求 MAID 有关(39 名愿意参与的参与者中有 33 名[84.6%]报告有 1 名或多名患者寻求 MAID,而 31 名不确定的参与者中有 15 名[48.4%]报告有 1 名或多名患者寻求 MAID)。较高的知识和舒适度得分均与增加愿意参与的可能性显著相关(优势比,每增加 1 分[95%CI,1.03-1.27];P = .01)与不确定(1.18 [95%CI,1.07-1.30;P = .001)。

结论和相关性:这项调查研究的结果表明,肿瘤学 APP 可能需要为将 MAID 添加到他们的实践范围做好准备。这项研究还提出了未来关于支持可能考虑参与 MAID 但对自己的角色或希望医生参与表示质疑的 APP 的问题。

相似文献

[1]
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[2]
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[5]
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Willingness to be present throughout patient death via medical aid in dying in a national sample of interdisciplinary US hospice clinicians: a content analysis of rationales.

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本文引用的文献

[1]
Physicians' Attitudes and Experiences with Medical Aid in Dying in Colorado: a "Hidden Population" Survey.

J Gen Intern Med. 2022-10

[2]
Tennessee Healthcare Provider Practices, Attitudes, and Knowledge Around HIV Pre-Exposure Prophylaxis.

J Prim Care Community Health. 2020

[3]
Use of a State Registry to Compare Practices of Physicians and Nurse Practitioners in Completing Physician Orders for Life-Sustaining Treatment Forms.

J Palliat Med. 2021-7

[4]
Assisted dying around the world: a status quaestionis.

Ann Palliat Med. 2021-3

[5]
Knowledge, Attitudes, and PrEP Prescribing Practices of Health Care Providers in Philadelphia, PA.

J Prim Care Community Health. 2019

[6]
Trends in Medical Aid in Dying in Oregon and Washington.

JAMA Netw Open. 2019-8-2

[7]
Advanced Practice Nursing student knowledge in obesity management: A mixed methods research study.

Nurse Educ Today. 2019-3-30

[8]
A survey of the attitudes, beliefs and knowledge about medical cannabis among primary care providers.

BMC Fam Pract. 2019-1-22

[9]
Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer.

Front Public Health. 2018-6-11

[10]
Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate.

J Gen Intern Med. 2018-5-2

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