• Gilla K Shapiro, Eryn Tong, Rinat Nissim, Camilla Zimmermann, Sara Allin, Jennifer L Gibson, Sharlane C L Lau, Madeline Li, and Gary Rodin.
• Department of Supportive Care (Shapiro, Tong, Nissim, Zimmermann, Lau, Li, Rodin), Princess Margaret Cancer Centre; Global Institute of Psychosocial, Palliative and End-of-Life Care (Shapiro, Zimmermann, Li, Rodin), University of Toronto and Princess Margaret Cancer Centre; Department of Psychiatry (Shapiro, Nissim, Zimmermann, Li, Rodin), Faculty of Medicine, University of Toronto; Social & Behavioural Health Sciences Division (Shapiro), Dalla Lana School of Public Health, University of Toronto; Department of Medicine (Zimmermann), Faculty of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Zimmermann, Allin, Gibson), Joint Centre for Bioethics (Gibson), and Epidemiology Division (Rodin), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. gilla.shapiro@uhn.ca.
• CMAJ. 2024 Feb 25; 196 (7): E222E234E222-E234.

BackgroundMedical assistance in dying (MAiD) was legalized in Canada in 2016, but coordination of MAiD and palliative and end-of-life care (PEOLC) services remains underdeveloped. We sought to understand the perspectives of health leaders across Canada on the relationship between MAiD and PEOLC services and to identify opportunities for improved coordination.MethodsIn this quantitative study, we purposively sampled health leaders across Canada with expertise in MAiD, PEOLC, or both. We conducted semi-structured interviews between April 2021 and January 2022. Interview transcripts were coded independently by 2 researchers and reconciled to identify key themes using content analysis. We applied the PATH framework for Integrated Health Services to guide data collection and analysis.ResultsWe conducted 36 interviews. Participants expressed diverse views about the optimal relationship between MAiD and PEOLC, and the desirability of integration, separation, or coordination of these services. We identified 11 themes to improve the relationship between the services across 4 PATH levels: client-centred services (e.g., educate public); health operations (e.g., cultivate compassionate and proactive leadership); health systems (e.g., conduct broad and inclusive consultation and planning); and intersectoral initiatives (e.g., provide standard practice guidelines across health care systems).InterpretationHealth leaders recognized that cooperation between MAiD and PEOLC services is required for appropriate referrals, care coordination, and patient care. They identified the need for public and provider education, standardized practice guidelines, relationship-building, and leadership. Our findings have implications for MAiD and PEOLC policy development and clinical practice in Canada and other jurisdictions.© 2024 CMA Impact Inc. or its licensors.

8 keywords...

hide…