Hospice Care Provider Perspectives of Medical Assistance in Dying in a Canadian Hospice That Does Not Provide Medical Assistance in Dying.

Abstract

Medical assistance in Dying (MAiD) is offered across diverse settings, including hospices. There is little research exploring the experiences of hospice care providers who support patients who undergo MAiD at an off-site location. To describe hospice care provider perceptions of MAiD in an in-patient hospice facility that does not provide MAiD. Participants included hospice administrators, nurses, staff and volunteers who provide care at an in-patient hospice facility in a geographically isolated medium sized city (population <100,000) in a western Canadian province. Using a qualitative descriptive approach, eight in-depth semi-structured interviews were undertaken. Data were digitally recorded, transcribed, analyzed inductively, and organized thematically. Introduction of MAiD challenged and disrupted care practices. Themes included: Situating MAiD within hospice and palliative care, caring for patients undergoing MAiD within a non-provider facility, and balancing interpersonal dynamics in an interdisciplinary team environment. Themes were underpinned by participants' attempts to reconcile MAiD within personal beliefs and work environment. Caring for patients who chose MAiD changed the dynamic of care. Participants focused on providing patient-centred care while attempting to normalize the MAiD process. Educational resources to support patient-centred care for patients who undergo MAiD off-site, address care provider self-care, and to facilitate safe and effective interdisciplinary communication are needed.