Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
BMC Psychiatry. 2024 Feb 14;24(1):120. doi: 10.1186/s12888-024-05541-5.
Persons with mental illness as their sole underlying medical condition are eligible to access medical assistance in dying (MAiD) in a small number of countries, including Belgium, the Netherlands, Luxemburg and Switzerland. In Canada, it is anticipated that people experiencing mental illness as their sole underlying medical condition (MI-SUMC) will be eligible to request MAiD as of March 17th 2024. To date, few studies have addressed patient and family perspectives on MAiD MI-SUMC care processes. This study aimed to address this gap and qualitatively explore the perspectives of persons with lived experience of mental illness and family members on care considerations during MI-SUMC implementation.
Thirty adults with lived experience of mental illness and 25 adult family members residing in Ontario participated in this study. To facilitate participant engagement, the semi-structured interview used a persona-scenario exercise to discuss perspectives on MAiD MI-SUMC acceptability and care considerations. Framework analysis was used to inductively analyze data using NVivo 12 Pro. Steps, processes, or other care considerations suggested by the participants were charted in a framework matrix after familiarization with the narratives. Key themes were further identified. A lived-experience advisory group participated in every aspect of this study.
Six themes were developed from the patient and family narratives: (1) Raising MAiD MI-SUMC awareness; (2) Sensitive Introduction of MAiD MI-SUMC in goals of care discussions; (3) Asking for MAiD MI-SUMC: a person-focused response; (4) A comprehensive circle of MAiD MI-SUMC care; (5) A holistic, person-centered assessment process; and (6) Need for support in the aftermath of the decision. These themes highlighted a congruence of views between patient and family members and described key desired process ingredients, including a person-centred non-judgmental stance by care providers, inter-professional holistic care, shared decision making, and the primacy of patient autonomy in healthcare decision making.
Family and patient perspectives on the implementation of MAiD MI-SUMC offer important considerations for service planning that could complement existing and emerging professional practice standards. These stakeholders' perspectives will continue to be essential in MAiD MI-SUMC implementation efforts, to better address the needs of diverse communities and inform improvement efforts.
在少数国家，包括比利时、荷兰、卢森堡和瑞士，只有精神疾病作为唯一潜在医学条件的人有资格获得医疗辅助死亡（MAiD）。在加拿大，预计从 2024 年 3 月 17 日起，只有精神疾病作为唯一潜在医学条件（MI-SUMC）的人将有资格请求 MAiD。迄今为止，很少有研究涉及患者和家属对 MAiD MI-SUMC 护理过程的看法。这项研究旨在解决这一差距，并定性探讨有精神疾病患者和家属对 MI-SUMC 实施过程中护理考虑因素的看法。
本研究共有 30 名有精神疾病患者和 25 名居住在安大略省的成年家属参与。为了促进参与者的参与，半结构化访谈采用人物角色情景练习来讨论 MAiD MI-SUMC 可接受性和护理考虑因素的看法。采用 NVivo 12 Pro 进行框架分析，对数据进行归纳分析。在熟悉叙述后，将参与者提出的步骤、流程或其他护理考虑因素记录在框架矩阵中。进一步确定了关键主题。一个有经验的咨询小组参与了研究的各个方面。
从患者和家属的叙述中得出了六个主题：（1）提高 MAiD MI-SUMC 的认识；（2）在目标护理讨论中敏感地引入 MAiD MI-SUMC；（3）请求 MAiD MI-SUMC：以个人为中心的回应；（4）全面的 MAiD MI-SUMC 护理圈；（5）全面的、以患者为中心的评估过程；（6）决策后的支持需求。这些主题突出了患者和家属观点之间的一致性，并描述了关键的期望过程要素，包括护理提供者的以患者为中心、非评判性立场、跨专业的整体护理、共同决策以及患者在医疗保健决策中的自主权首要地位。
家庭和患者对 MAiD MI-SUMC 实施的看法为服务规划提供了重要的考虑因素，可以补充现有的和新兴的专业实践标准。这些利益相关者的观点将继续在 MAiD MI-SUMC 的实施工作中至关重要，以更好地满足不同社区的需求，并为改进工作提供信息。
