How we can improve the quality of care for patients requesting medical assistance in dying: a qualitative study of health care providers.

Abstract: Context Since Canada decriminalized medical assistance in dying (MAID) in 2015, clinicians and organizations have developed policies and protocols to implement assisted dying in clinical practice. Five years on, there is little consensus as to what constitutes high-quality care in MAID. Objectives To describe MAID clinicians’ perspectives on quality of care in MAID, including challenges, successes, and clinical practice suggestions. Methods We conducted an exploratory, multi-centre, qualitative study at four Canadian centres. Using a semi-structured interview guide, we conducted interviews with 20 health care providers. Interviews were transcribed and de-identified prior to analysis. Adopting a qualitative descriptive approach, we used a thematic analysis to identify primary and secondary themes in the interviews and practice suggestions to improve quality of care to patients who request MAID. Results We identified three major themes. 1) Improving access and patient experience: clinicians described struggles in ensuring equitable access to MAID and supporting MAID patients and their families. 2) Supporting providers and sustainability: clinicians described managing MAID workload, remuneration, educational needs, and the emotional impact of participating in assisted dying. 3) Institutional support: descriptions of MAID communication tools and training, use of standardized care pathways, inter-professional collaboration, and human resource planning. Clinicians also described suggestions for clinical practice to improve quality of care. Conclusion Canadian health care providers described unique challenges in caring for patients who request MAID, along with practices to improve the quality of care.