Becker Todd D, Cagle John G, Cain Cindy L, Davitt Joan K, Kusmaul Nancy, Sacco Paul
School of Medicine, Washington University in St. Louis, 600 South Taylor Avenue, MSC 8100-0094-2400, St. Louis, MO 63110, USA.
School of Social Work, University of Maryland, Baltimore, MD, USA.
Palliat Care Soc Pract. 2024 Dec 8;18:26323524241302097. doi: 10.1177/26323524241302097. eCollection 2024.
Despite extensive theoretical debate, empirical research on medical aid in dying (MAID) largely has disregarded broader, contextual factors as potential correlates of attitudes in hospice clinicians.
Informed by institutional theory and neofunctional attitude theory, the objective of the current study was to quantitatively examine hospice clinicians' attitudes toward MAID as functions of institutional characteristics relating to (Aim 1) individual adherence to hospice values and (Aim 2) state law.
We used a cross-sectional design.
A national convenience sample of interdisciplinary hospice clinicians recruited through US professional membership associations self-administered an online survey. Measures included attitudes toward MAID, attitudes toward the hospice philosophy of care, attitudes toward the principle that hospice care should not hasten death, orientation toward patient-centeredness, professional exposure to working in a state where MAID is legal, and demographic characteristics. Data were analyzed via a partial proportional odds model.
The sample ( = 450) comprised hospice physicians (227 [50.4%]), nurses (64 [14.2%]), social workers (74 [16.4%]), and 85 chaplains (85 [18.9%]). Results of the partial proportional odds model indicated that professional exposure to working in a state where MAID is legal was significantly associated with over twice the cumulative odds of MAID support. Although neither orientation toward patient-centered care nor attitudes toward the hospice philosophy of care was significantly associated with attitudes toward MAID, results showed that disagreement with the narrower principle that hospice care should not hasten death was significantly associated with 6-to-7 times the cumulative odds of MAID support.
Findings suggest that contextual factors-namely, the environments in which hospice clinicians practice-may shape attitudes toward MAID. Unanticipated results indicating that hospice professionals' adherence to hospice values was not significantly associated with attitudes toward MAID underscore the need for further research on these complex associations, given previous theoretical and empirical support.
尽管存在广泛的理论争论，但关于临终医疗协助（MAID）的实证研究在很大程度上忽略了更广泛的背景因素，而这些因素可能与临终关怀临床医生的态度相关。
以制度理论和新功能态度理论为依据，本研究的目的是定量考察临终关怀临床医生对MAID的态度，将其作为与（目标1）个人对临终关怀价值观的遵循以及（目标2）州法律相关的制度特征的函数。
我们采用了横断面设计。
通过美国专业会员协会招募的全国性跨学科临终关怀临床医生便利样本自行进行了一项在线调查。测量内容包括对MAID的态度、对临终关怀护理理念的态度、对临终关怀护理不应加速死亡这一原则的态度、以患者为中心的取向、在MAID合法的州工作的专业经历以及人口统计学特征。数据通过部分比例优势模型进行分析。
样本（n = 450）包括临终关怀医生（227名[50.4%]）、护士（64名[14.2%]）、社会工作者（74名[16.4%]）和85名牧师（85名[18.9%]）。部分比例优势模型的结果表明，在MAID合法的州工作的专业经历与支持MAID的累积几率高出两倍多显著相关。尽管以患者为中心的护理取向和对临终关怀护理理念的态度均与对MAID的态度无显著关联，但结果显示，不同意临终关怀护理不应加速死亡这一狭义原则与支持MAID的累积几率高出6至7倍显著相关。
研究结果表明，背景因素——即临终关怀临床医生的执业环境——可能会塑造对MAID的态度。鉴于先前的理论和实证支持，意外的结果表明临终关怀专业人员对临终关怀价值观的遵循与对MAID的态度无显著关联，这凸显了对这些复杂关联进行进一步研究的必要性。
