From the Guidelines
Medical Assistance in Dying (MAiD) in oncology patients at Canadian academic hospitals is a complex process that prioritizes patient autonomy, symptom management, and multidisciplinary care, as reflected in the recent guidelines for palliative care in cancer patients 1. The experience of a Canadian academic hospital with MAiD in oncology patients is influenced by guidelines that emphasize the importance of early specialist palliative care involvement, especially for patients with uncontrolled symptoms and/or quality of life concerns 1. Key aspects of MAiD in this context include:
- A structured process that begins with patient request and requires assessment by two independent physicians or nurse practitioners
- Common reasons for seeking MAiD among cancer patients, such as loss of autonomy, inability to engage in meaningful activities, and uncontrolled symptoms
- A typical medication protocol that includes midazolam, lidocaine, propofol, and rocuronium or cisatracurium, with dosing based on weight
- The need for a multidisciplinary approach involving palliative care specialists, oncologists, psychiatrists, and social workers to ensure patients meet eligibility criteria The guidelines from the Journal of Clinical Oncology 1 highlight the importance of referring patients with advanced cancer to specialized interdisciplinary palliative care teams, which can provide essential components of palliative care, including symptom management, exploration of understanding and education about illness and prognosis, and assistance with medical decision making. In the context of MAiD, these guidelines support the integration of palliative care into comprehensive cancer care, while maintaining ethical standards and respecting patient autonomy, as reflected in the Canadian experience with MAiD in oncology patients 1.
From the Research
Experience of Canadian Academic Hospital with MAiD in Oncology Patients
- A Canadian academic hospital's experience with Medical Assistance in Dying (MAiD) in oncology patients was studied, and the results showed that 92 oncology patients received MAiD between June 2016 and July 2020 2.
- The median age of these patients was 72, and the leading cancer diagnoses were lung, colorectal, and pancreatic cancer.
- At the time of MAiD request, 68% of patients had metastatic disease, and 90% had an ECOG performance status of 3 or 4.
- Most patients (99%) had distressing symptoms at the time of MAiD request, with pain being the most common symptom.
Characteristics of Oncology Patients Receiving MAiD
- A review of patients with cancer who underwent MAiD found that 79% had metastatic disease, and the most prevalent solid organ tumors were gastrointestinal, lung, and genitourinary 3.
- MAiD was primarily provided in the home or an acute inpatient facility, and 74% of patients were evaluated by medical oncology.
- Common reasons for pursuing MAiD included disease-related symptoms, fear of future suffering or disability, and the ability to control the time and manner of death.
Collaborative Approach to MAiD in Cancer Patients
- A collaborative approach between a centralized coordination service and a regional cancer centre was found to be an effective strategy for enabling interdisciplinary care delivery and enhancing patient-centred care at the end of the patient's cancer journey 4.
- This approach can help improve access to MAiD for patients with advanced cancer and ensure that their needs are met in a timely and compassionate manner.
Patient and Family Perspectives on MAiD
- A qualitative study found that patients and families identified the need for care coordination and a patient-centred approach as central to high-quality care in MAiD 5.
- Patients and families also identified process-specific successes and challenges during the process of MAiD, highlighting the importance of understanding their perspectives and experiences.
- The study suggests that more research is required to characterize which aspects of care most influence patient and family satisfaction with MAiD.