COVID-19 对在医院接受医疗协助死亡的患者及其家属照顾者的体验的影响。
The impact of COVID-19 on the experiences of patients and their family caregivers with medical assistance in dying in hospital.
机构信息
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, Toronto, ON, Canada.
Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
出版信息
BMC Palliat Care. 2023 Jun 13;22(1):70. doi: 10.1186/s12904-023-01191-8.
BACKGROUND
The COVID-19 pandemic and its containment measures have drastically impacted end-of-life and grief experiences globally, including those related to medical assistance in dying (MAiD). No known qualitative studies to date have examined the MAiD experience during the pandemic. This qualitative study aimed to understand how the pandemic impacted the MAiD experience in hospital of persons requesting MAiD (patients) and their loved ones (caregivers) in Canada.
METHODS
Semi-structured interviews were conducted with patients who requested MAiD and their caregivers between April 2020 and May 2021. Participants were recruited during the first year of the pandemic from the University Health Network and Sunnybrook Health Sciences Centre in Toronto, Canada. Patients and caregivers were interviewed about their experience following the MAiD request. Six months following patient death, bereaved caregivers were interviewed to explore their bereavement experience. Interviews were audio-recorded, transcribed verbatim, and de-identified. Transcripts were analyzed using reflexive thematic analysis.
RESULTS
Interviews were conducted with 7 patients (mean [SD] age, 73 [12] years; 5 [63%] women) and 23 caregivers (mean [SD] age, 59 [11] years; 14 [61%] women). Fourteen caregivers were interviewed at the time of MAiD request and 13 bereaved caregivers were interviewed post-MAiD. Four themes were generated with respect to the impact of COVID-19 and its containment measures on the MAiD experience in hospital: (1) accelerating the MAiD decision; (2) compromising family understanding and coping; (3) disrupting MAiD delivery; and (4) appreciating rule flexibility.
CONCLUSIONS
Findings highlight the tension between respecting pandemic restrictions and prioritizing control over the dying circumstances central to MAiD, and the resulting impact on patient and family suffering. There is a need for healthcare institutions to recognize the relational dimensions of the MAiD experience, particularly in the isolating context of the pandemic. Findings may inform strategies to better support those requesting MAiD and their families during the pandemic and beyond.
背景
COVID-19 大流行及其遏制措施在全球范围内极大地影响了临终和悲伤体验，包括与医疗协助死亡（MAiD）相关的体验。迄今为止，尚无已知的定性研究探讨大流行期间的 MAiD 体验。本定性研究旨在了解大流行如何影响加拿大请求 MAiD 的患者（患者）及其家属（护理人员）在医院的 MAiD 体验。
方法
2020 年 4 月至 2021 年 5 月期间，对请求 MAiD 的患者及其护理人员进行了半结构化访谈。参与者是在大流行的第一年从加拿大多伦多的大学健康网络和森尼布鲁克健康科学中心招募的。患者和护理人员就 MAiD 请求后的体验接受了采访。在患者去世后六个月，对悲痛欲绝的护理人员进行了采访，以探讨他们的丧亲体验。采访以音频形式记录，逐字转录，并进行了身份识别。使用反思性主题分析对转录本进行了分析。
结果
对 7 名患者（平均[标准差]年龄 73[12]岁；5[63%]名女性）和 23 名护理人员进行了采访（平均[标准差]年龄 59[11]岁；14[61%]名女性）。在 MAiD 请求时对 14 名护理人员进行了采访，在 MAiD 后对 13 名丧亲护理人员进行了采访。围绕 COVID-19 及其遏制措施对医院 MAiD 体验的影响产生了四个主题：（1）加速 MAiD 决策；（2）损害家庭的理解和应对能力；（3）扰乱 MAiD 交付；（4）欣赏规则的灵活性。
结论
研究结果强调了在尊重大流行限制和优先考虑控制与 MAiD 相关的临终情况之间的紧张关系，以及对患者和家庭痛苦的影响。医疗机构有必要认识到 MAiD 体验的关系维度，尤其是在大流行期间的孤立背景下。研究结果可能为在大流行期间及以后更好地支持那些请求 MAiD 的人和他们的家庭提供策略。
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