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Yang JM, Lee SK, Kim JH. Association Between Objective Social Isolation and Unmet Medical Needs: A Nationwide Cross-sectional Study in Korea. J Prev Med Public Health 2024; 57:242-251. [PMID: 38697912 PMCID: PMC11164600 DOI: 10.3961/jpmph.23.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/12/2024] [Accepted: 03/15/2025] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES The aim of this study was to analyze the relationship between objective social isolation (SI) and unmet medical needs (UMN) in adults aged 19 and older. METHODS A cross-sectional analysis was conducted of 208 619 adults aged 19 and older, excluding missing data, using the 2019 Korea Community Health Survey. To analyze the association between objective SI and UMN, the chi-square test and logistic regression analysis were performed. RESULTS The prevalence of UMN was 1.14 times higher (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06 to 1.23) among those with SI than among those without SI, and the OR for groups with 5 SI types was 2.77 (95% CI, 1.86 to 4.12) compared to those with no SI types. In addition, a stratified analysis by age group showed that the association between SI and UMN existed even in groups under 64 years old. However, among those aged 65 and older, SI was associated with an OR of 1.53 (95% CI, 1.37 to 1.71) for UMN compared to non-SI. As the number of SI types increased, the prevalence of UMN also increased, indicating a strong association between SI and UMN in older adults. CONCLUSIONS This study found that individuals with SI experienced UMN due to fear and anxiety about interpersonal relationships. Therefore, based on the results of this cross-sectional study, it is necessary to investigate the causal relationship between SI and UMN through future longitudinal data.
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Affiliation(s)
- Jeong Min Yang
- Department of Public Health, General Graduate School of Dankook University, Cheonan, Korea
| | - Seul Ki Lee
- Department of Public Health, General Graduate School of Dankook University, Cheonan, Korea
| | - Jae Hyun Kim
- Department of Health Administration, Dankook University College of Health Science, Cheonan, Korea
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Bravo G, Delli-Colli N, Dumont I, Bouthillier ME, Rochette M, Trottier L. Characterizing Canadian Social Workers Willing to Be Involved in Medical Assistance in Dying for Persons Lacking Decisional Capacity. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:19-34. [PMID: 37366348 DOI: 10.1080/01634372.2023.2229397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
Medical assistance in dying (MAID) is available in Canada for competent persons meeting the legal requirements. Extending access to persons lacking decisional capacity is being considered. Social workers may be called upon to accompany these persons through the MAID process. As part of a larger survey, we asked social workers from Quebec whether they would be willing to be involved should advance requests for MAID be legalized. Of the 367 respondents, 291 replied that they would. Using multivariable logistic regression, we identified characteristics that distinguish them from the other social workers surveyed: importance of religious or spiritual beliefs, being born in Canada, having received assisted-death requests from families, professional experiences with MAID, and dreading the prospect of participating in MAID for persons lacking decisional capacity. These findings underline the need for educational interventions that would increase social workers' confidence in providing high-quality care to clients who opt for MAID.
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Affiliation(s)
- Gina Bravo
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nathalie Delli-Colli
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Dumont
- School of Social Work, Université du Québec à Montréal, Montréal, Canada
| | - Marie-Eve Bouthillier
- Office of Clinical Ethics, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Marianne Rochette
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Montréal, Canada
| | - Lise Trottier
- Research Centre on Aging, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada
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Close E, Downie J, White BP. Practitioners' experiences with 2021 amendments to Canada's medical assistance in dying law: a qualitative analysis. Palliat Care Soc Pract 2023; 17:26323524231218282. [PMID: 38148894 PMCID: PMC10750527 DOI: 10.1177/26323524231218282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/16/2023] [Indexed: 12/28/2023] Open
Abstract
Background In 2016, Canada joined the growing number of jurisdictions to legalize medical assistance in dying (MAiD), when the Supreme Court of Canada's decision in Carter v Canada took effect and the Canadian Parliament passed Bill C-14. Five years later, Bill C-7 introduced several significant amendments. These included removing the 'reasonably foreseeable natural death' requirement (an aspect that was widely debated) and introducing the final consent waiver. Since Bill C-7 is so new, very little research has investigated its operation in practice. Objectives This study investigates the experiences of MAiD assessors and providers regarding the Bill C-7 amendments. It explores implications for understanding and improving regulatory reform and implementation. Design Qualitative thematic analysis of semi-structured interviews. Methods In all, 32 MAiD assessors and providers (25 physicians and 7 nurse practitioners) from British Columbia (n = 10), Ontario (n = 15) and Nova Scotia (n = 7) were interviewed. Results The analysis resulted in five themes: (1) removing barriers to MAiD access; (2) navigating regulatory and systems recalibration; (3) recognizing workload burdens; (4) determining individual ethical boundaries of practice and (5) grappling with ethical tensions arising from broader health system challenges. Conclusion This is one of the first studies to investigate physicians' and nurse practitioners' experiences of the impact of Bill C-7 after the legislation was passed. Bill C-7 addressed key problems under Bill C-14, including the two witnesses requirement and the 10-day waiting period. However, it also introduced new complexities as practitioners decided how to approach cases involving a non-reasonably foreseeable natural death (and contemplated the advent of MAiD for persons with a mental disorder as a sole underlying condition). This study highlights the importance of involving practitioners in advance of legislative changes. It also emphasizes how the regulation of MAiD involves a range of organizations, which requires strong leadership and coordination from the government.
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Affiliation(s)
- Eliana Close
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001, Australia
| | - Jocelyn Downie
- Health Law Institute, Faculty of Law and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ben P. White
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
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Gallagher R, Coelho R, Violette PD, Gaind KS, Chochinov HM. Response to Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability. J Palliat Med 2023; 26:1610-1617. [PMID: 37955548 PMCID: PMC10714107 DOI: 10.1089/jpm.2023.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/14/2023] Open
Abstract
This report, signed by >170 scholars, clinicians, and researchers in palliative care and related fields, refutes the claims made by the previously published Medical Assistance in Dying, Palliative Care, Safety, and Structural Vulnerability. That report attempted to argue that structural vulnerability was not a concern in the provision of assisted dying (AD) by a selective review of evidence in medical literature and population studies. It claimed that palliative care has its own safety concerns, and that "misuse" of palliative care led to reports of wrongful death. We and our signatories do not feel that the conclusions reached are supported by the evidence provided in the contested report. The latter concluded that the logical policy response would be to address the root causes of structural vulnerability rather than restrict access to AD. Our report, endorsed by an international community of palliative care professionals, believes that public policy should aim to reduce structural vulnerability and, at the same time, respond to evidence-based cautions about AD given the potential harm.
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Affiliation(s)
- Romayne Gallagher
- Division of Palliative Care, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Philippe D. Violette
- Department of Surgery, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - K. Sonu Gaind
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Harvey Max Chochinov
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Cancer Care Manitoba Research Institute, Winnipeg, Manitoba, Canada
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Young J, Snelling J, Beaumont S, Diesfeld K, White B, Willmott L, Robinson J, Ahuriri-Driscoll A, Cheung G, Dehkhoda A, Egan R, Jap J, Karaka-Clarke TH, Manson L, McLaren C, Winters J. What do health care professionals want to know about assisted dying? Setting the research agenda in New Zealand. BMC Palliat Care 2023; 22:40. [PMID: 37038170 PMCID: PMC10084592 DOI: 10.1186/s12904-023-01159-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND New Zealand recently introduced law permitting terminally ill people to request and receive assisted dying (AD) in specified circumstances. Given the nature and complexity of this new health service, research is vital to determine how AD is operating in practice. OBJECTIVE To identify research priorities regarding the implementation and delivery of AD in New Zealand. METHODS Using an adapted research prioritisation methodology, the researchers identified 15 potential AD research topics. A mixed-methods survey of health professionals was undertaken where respondents were asked to rate the 15 topics according to the relative importance for research to be conducted on each issue. Respondents could also suggest additional research areas, and were invited to participate in a follow-up interview. RESULTS One hundred and nineteen respondents completed the survey. 31% had some experience with AD. The highest rated research topic was the 'effectiveness of safeguards in the Act to protect people'; the lowest rated topic was research into the 'experiences of non-provider (e.g., administrative, cleaning) staff where assisted dying is being provided'. Respondents suggested 49 other research topics. Twenty-six interviews were conducted. Thematic analysis of interview data and open-ended survey questions was undertaken. Six research themes were identified: general factors related to the wider health system; the experiences of health care providers at the bedside; medico-legal issues; the impact of AD; experiences on the day of dying; and the overall effectiveness of the AD system. Key issues for stakeholders included safety of the AD service; ensuring access to AD; achieving equity for 'structurally disadvantaged' groups; and ensuring the well-being of patients, families/whānau, providers and non-providers. CONCLUSIONS Based on early experiences of the implementation of the AD service, health professionals provide important insights into what research should be prioritised post-legalisation of AD. These findings can be used to shape the research agenda so that research may inform law, policy and best practice.
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Affiliation(s)
- Jessica Young
- Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand.
| | | | - Sophie Beaumont
- Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Kate Diesfeld
- Auckland University of Technology, Auckland, New Zealand
| | - Ben White
- Queensland University of Technology, Brisbane, Australia
| | - Lindy Willmott
- Queensland University of Technology, Brisbane, Australia
| | | | | | - Gary Cheung
- University of Auckland, Auckland, New Zealand
| | | | | | - James Jap
- Tōtara Hospice, Auckland, New Zealand
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Rivest J, Rouly G, Brouillette MJ, Nguyen O, Desbeaumes Jodoin V. Improving Palliative Care and Medical Assistance in Dying Practice in Canada: How Patients-Partners Could Contribute to Continuing Medical Education. Palliat Med Rep 2023; 4:116-119. [PMID: 37095864 PMCID: PMC10122257 DOI: 10.1089/pmr.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
Medical Assistance in Dying (MAiD) is still considered an evolving practice in Canada. Practitioners are facing the challenge of staying up to date and hence need efficient continuing medical education (CME). A patient-partner has been recently invited as a keynote speaker to CME activities in Canada to share her perspectives and views about patient engagement in palliative care and MAiD practice, calling for compassion. To our knowledge, few data exist on patient-partners' contribution to CME on these topics. Based on that experience, we discuss different issues on patient engagement's contribution in such CME events and call for further research.
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Affiliation(s)
- Jacynthe Rivest
- Department of Psychiatry, Centre Hospitalier de l'Universite de Montreal (CHUM) and Centre de Recherche du CHUM (CRCHUM), Montreal, Québec, Canada
- Address correspondence to: Jacynthe Rivest, MD, MA(Ed), FRCPC, Department of Psychiatry, Centre Hospitalier de l'Universite de Montreal (CHUM) and Centre de Recherche du CHUM (CRCHUM), 1051 rue Sanguinet, Montreal, Québec H2X 0C1, Canada.
| | - Ghislaine Rouly
- Centre of Excellence on Partnership with Patients and the Public, Montreal, Québec, Canada
| | - Marie-Josée Brouillette
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Department of Psychiatry, McGill University Health Centre, Montreal, Québec, Canada
| | - Olivia Nguyen
- Palliative Care Division, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Québec, Canada
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Véronique Desbeaumes Jodoin
- Department of Psychiatry, Centre Hospitalier de l'Universite de Montreal (CHUM) and Centre de Recherche du CHUM (CRCHUM), Montreal, Québec, Canada
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