Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2018 ASCO Annual Meeting but not presented at the Meeting, can be found online only.
Medical assistance in dying in British Columbia: Attitudes and experiences of oncology practitioners in the first year of legalization.
Patient and Survivor Care
2018 ASCO Annual Meeting
J Clin Oncol 36, 2018 (suppl; abstr e22002)
Author(s): David William Fenton; BC Cancer Agency Vancouver Island Centre, Victoria, BC, Canada
Background: MAiD was legalized in Canada June 17, 2016. Most patients who request MAiD have incurable cancer but oncologists had been somewhat resistant to MAiD legalization. The aim of this study was to assess the experiences and attitudes of oncology practitioners in BC one year after legalization and inform the process moving forward. Methods: A survey was sent to 280 practitioners with responses converted to a 3-point Likert scale: Agree, Disagree, Neither. Results: Of the 44% who responded, 46.3% were medical oncologist, 30.1% radiation oncologists, 11% general practitioners of oncology and 12% nurse practitioners of oncology. In the prior year, most (72.6%) had a patient declare an interest in MAiD, 13.1% had done an assessment, less than 1% had provided MAiD, 35.8% indicated they would probably be assessors and 9.7% would be willing to provide MAiD in the future while 20.3% considered themselves conscientious objectors. Challenges included: difficulty with key eligibility criteria and assessing vulnerability (28.2% to 44.1%), insufficient time for assessments (35.5%), concern about prosecution or professional sanctions (31.5%), concerns over worsening work quality of life (48.4%), shifting focus from equitable access to high quality palliative care (31.7%) and damage to the patient-practitioner relationship (15.3%). Improving the process for cancer patients in the future could include ensuring an oncology practitioner is always one of the assessors (50.8%), always having an evaluation by the palliative care team (72.6%) and referral to a multidisciplinary MAiD assessment team (70.2%) and/or specialized MAiD provision service (73.4%). Conclusions: Most respondents were approached about MAiD but few became involved in the process. This may not be optimal. There are legitimate concerns driving this disparity that can likely be improved with further education and practice modification. This survey highlights several possible mechanisms by which the MAiD process in BC can be improved for cancer patients.