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Boven C, Dillen L, Van Humbeeck L, Van Den Block L, Piers R, Van Den Noortgate N. Relatives' needs in terms of bereavement care throughout euthanasia processes: A qualitative study. J Clin Nurs 2024; 33:3259-3272. [PMID: 38661114 DOI: 10.1111/jocn.17185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
AIM To explore relatives' needs in terms of bereavement care during euthanasia processes, how healthcare providers respond to these needs, and the degree of commonality between relatives' and healthcare providers' reports. DESIGN A phenomenological design was employed, utilising reflexive thematic analysis to examine interviews conducted with relatives (N = 19) and healthcare providers (N = 47). RESULTS Relatives' needs throughout euthanasia processes are presented in five main themes and several subthemes, with similar findings between both sets of participants. Although relatives infrequently communicated their needs explicitly to healthcare providers, they appreciated it when staff proactively met their needs. Healthcare providers aimed to assist with the relatives' grief process by tending to their specific needs. However, aftercare was not consistently offered, but relatives did not have high expectations for professional follow-up care. CONCLUSION Our research offers important directions for healthcare professionals, empowering them to provide needs-based bereavement care during euthanasia processes. Moreover, it emphasises the importance of recognising the unique needs of relatives and proactively addressing them in the period before the loss to positively contribute to relatives' grief process. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Insights into relatives' needs in the context of euthanasia. Good practices on how healthcare providers can attend to relatives' needs before, during and after the loss IMPACT: Current literature and guidelines on needs-based bereavement care in the context of euthanasia and, more generally, assisted dying, are limited. These findings provide concrete directions for practice in supporting (nearly) bereaved relatives in the context of euthanasia, potentially mitigating adverse health outcomes. REPORTING METHOD Standards for Reporting Qualitative Research (SRQR checklist). PATIENT OR PUBLIC CONTRIBUTION Relatives of deceased cancer patients were involved in the conduct of the study.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | | | - Lieve Van Den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels Health Campus, Brussels, Belgium
- End-of-Life Care Research Group, Ghent University, Campus Ghent University Hospital, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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2
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Verdaguer M, Beroiz-Groh P, Busquet-Duran X, Moreno-Gabriel E, Arreciado Marañón A, Feijoo-Cid M, Domènech M, Íñiguez-Rueda L, Vallès-Peris N, Cantarell-Barella G, Toran-Monserrat P. [The euthanasia law and professional experiences: tensions in clinical practice]. GACETA SANITARIA 2024:S0213-9111(24)00020-7. [PMID: 38472012 DOI: 10.1016/j.gaceta.2024.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To analyze the process of assisted death provision in Catalonia and identify the main tensions, difficulties, and/or sources of discomfort related to professional practice. METHOD A qualitative study was conducted based on interviews (n=29) and focus groups (n=19) with professionals who participated in the euthanasia process. The selection of participants combined the snowball and maximization of variability procedures, taking into account the variables of professional profile, setting, gender, age and territoriality. Intentional and theoretical sampling process. RESULTS The assisted death process is divided into four main moments: 1) reception of the request, 2) medical-bureaucratic procedure, 3) the actual procedure, and 4) closure. At each of these moments, difficulties arise that can be a source of discomfort and have to do with the limits and tensions between the legal and moral, the conception of one's own professional role, the lack of recognition of some professional roles, stress and overload, the lack of formal and informal support, and the relationship with the patient and his/her family. The bureaucratic-administrative stress derived from a protective law, with both prior and subsequent verifying control, stands out, given that it stresses the professionals immersed in a healthcare system already under high pressure after budget cuts and the COVID-19 epidemic. CONCLUSIONS Throughout the assisted death process, the sources of distress are diverse and of a psychological, psychosocial, and structural nature. These results may lead to interventions for psychological and peer support, information, training, institutional involvement, and burden reduction.
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Affiliation(s)
- Maria Verdaguer
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Departament de Psicologia Social, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España.
| | - Patricia Beroiz-Groh
- Hospital Germans Trias i Pujol, Badalona (Barcelona), España; Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Xavier Busquet-Duran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España; Programa d'Atenció Domiciliària Equip de Suport, Servei d'Atenció Primària Vallès Oriental, Institut Català de la Salut, Granollers (Barcelona), España
| | - Eduard Moreno-Gabriel
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España
| | - Antonia Arreciado Marañón
- Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España; Departament d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Maria Feijoo-Cid
- Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España; Departament d'Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Miquel Domènech
- Departament de Psicologia Social, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Lupicinio Íñiguez-Rueda
- Departament de Psicologia Social, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | - Núria Vallès-Peris
- Institut d'investigació en Intel·ligència Artificial, Consejo Superior de Investigaciones Científicas (IIIA-CSIC), Bellaterra (Cerdanyola del Vallès, Barcelona), España; Barcelona Science and Technology Studies Group (STS-b), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès, Barcelona), España
| | | | - Pere Toran-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina, Mataró (Barcelona), España; Grup de Recerca Multidisciplinari en Salut i Societat, Barcelona, España
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3
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Boven C, Dillen L, Dierickx S, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. Relatives' Experiences of Being Involved in Assisted Dying: A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1154-1164. [PMID: 37791685 PMCID: PMC10626978 DOI: 10.1177/10497323231196827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Recent literature demonstrates an interdependence between relatives and healthcare providers throughout euthanasia processes. Yet, current guidelines and literature scarcely specify the interactions between healthcare providers and bereaved relatives. The aim of this work consisted of providing an insight into bereaved relatives' experiences (1) of being involved in euthanasia processes and (2) of their interactions with healthcare providers before, during, and after the euthanasia. The research process was guided by the principles of constructivist grounded theory. Nineteen Dutch-speaking bereaved relatives of oncological patients, who received euthanasia at home or in a hospital less than 24 months ago, participated via semi-structured interviews. These interviews were conducted between May 2021 and June 2022. Due to the intensity of euthanasia processes, relatives wanted to be involved as early as possible, in order to receive time, space, and access to professionals' support whilst preparing themselves for the upcoming loss of a family member with cancer. Being at peace with the euthanasia request facilitated taking a supportive attitude, subsequently aiding in achieving a serene atmosphere. A serene atmosphere facilitated relatives' grief process because it helped them in creating and preserving good memories. Relatives appreciated support from healthcare providers, as long as overinvolvement on their part was not occurring. This study advocates for a relational approach in the context of euthanasia and provides useful complements to the existing euthanasia guidelines.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Sigrid Dierickx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Selby D, Wortzman R, Bean S, Mills A. Perception of roles across the interprofessional team for delivery of medical assistance in dying. J Interprof Care 2023; 37:39-46. [PMID: 34915784 DOI: 10.1080/13561820.2021.1997947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In 2016, Canada joined many jurisdictions worldwide in legalizing Medical Assistance in Dying (MAiD). Given the paucity of qualitative research regarding the involvement of interprofessional health care providers (HCPs) in MAiD, the goal of this study was to better understand how HCPs viewed their role(s). Semi-structured interviews were conducted with 3 pharmacists, 10 nurses, and 8 social workers at an academic hospital in Toronto. Thematic analysis generated six broad themes: 1) Practical/Technical Component, 2) Education, 3) Support, 4) "Part of the Job," 5) "All of the Job," and 6) Lack of Published Information. While nurses and social workers espoused many commonalities, nursing roles were more "in the moment," whereas social workers viewed their roles as beginning earlier and extending after provision of MAiD. There was a spectrum of how participants perceived their role: pharmacists minimized the task of dispensing medications as an insignificant experience, nurses viewed involvement as consistent with their other professional duties (specifically non-MAiD deaths), and social workers described MAiD as a unique opportunity to employ the full gamut of their skills. The study highlights the importance of supporting HCPs through education and information at both regulatory and research levels, recognizing the key roles they play in MAiD.
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Affiliation(s)
- Debbie Selby
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Family and Community Medicine, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rachel Wortzman
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Family and Community Medicine, Toronto, Canada
| | - Sally Bean
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anneliese Mills
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anthropology, University of Toronto, Toronto, ON, Canada
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5
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Byrnes E, Ross AI, Murphy M. A Systematic Review of Barriers and Facilitators to Implementing Assisted Dying: A Qualitative Evidence Synthesis of Professionals' Perspectives. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221116697. [PMID: 35929771 DOI: 10.1177/00302228221116697] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Assisted dying is a divisive topic and draws both lamenting and approving commentary from political, medical, legal, and philosophical domains. This systematic review and qualitative evidence synthesis aims to identify the factors that healthcare professionals experience when working within assisted dying frameworks. PRISMA guidelines for systematic reviews were followed. Search results yielded 15,426 papers with 39 papers meeting inclusion criteria for this review. Remaining papers were subjected to critical appraisal and a thematic synthesis. Eight themes fell under the domain of 'barrier' and represented different personal and professional factors that hinder professionals from delivering assisted dying healthcare. Five themes came under the domain of 'facilitators' and represent factors that contribute to the smooth implementation and delivery of assisted dying services. Health professionals experience a range of factors that both impede and propel delivery of assisted dying frameworks.
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Affiliation(s)
- Eric Byrnes
- Department of Clinical Psychology, School of Applied Psychology, University College Cork, Clare, Ireland
- Cork Mental Health Services, Cork/Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Alasdair Iain Ross
- Department of Clinical Psychology, School of Applied Psychology, University College Cork, Clare, Ireland
- Cork Mental Health Services, Cork/Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Mike Murphy
- Department of Clinical Psychology, School of Applied Psychology, University College Cork, Clare, Ireland
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6
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Sandham M, Carey M, Hedgecock E, Jarden R. Nurses' experiences of supporting patients requesting voluntary assisted dying: A qualitative meta-synthesis. J Adv Nurs 2022; 78:3101-3115. [PMID: 35748092 PMCID: PMC9546017 DOI: 10.1111/jan.15324] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/24/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
Aim Describe the reported lived experiences of nurses who have participated at any stage of voluntary assisted dying (VAD), from the initial request to the end of life. Design A qualitative meta‐synthesis. Data sources Databases searched were CINAHL, MEDLINE, Emcare, Scopus and PsycInfo. The search was undertaken in September 2021 with no date limitations. Qualitative studies were considered if published in English, reported primary data analysis of nurses' experiences who had been involved in VAD and reported direct quotes from nurses. Review methods Qualitative studies meeting the selection criteria were critically appraised, then an open card‐sort method was applied. Quotes from nurses were organized to group similar experiences, constructing themes and metaphors across studies as a new understanding of nurses' experiences of VAD. Results Eight studies were included. Three major themes were constructed: An orderly procedure, reflecting the need for structure to feel adequately prepared; A beautiful death, reflecting the autonomy the patient exercised when choosing VAD facilitated an exceptionally positive death; and Psychological and emotional impact, where nurses recognized the emotional and ethical weight that they carried for themselves and the team when undertaking VAD. Conclusion Nurses may benefit from clear policy, supervision and communication training to support them as countries transition to providing VAD services. Policy provides nurses with confidence that they are undertaking the steps of VAD correctly and provides a layer of emotional protection. Communication training specific to VAD is necessary to prepare nurses to recognize their own emotional experiences when responding to the needs of the patient and their family. Impact VAD is increasingly becoming a legal option that nurses are encountering in their professional practice. Understanding nurses' experiences of being involved in VAD is required to support nurses in countries where VAD is becoming available to prepare professionally and psychologically.
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Affiliation(s)
- Margaret Sandham
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Melissa Carey
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.,School of Nursing, University of Auckland. School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | | | - Rebecca Jarden
- Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Austin Health, Heidelberg, Australia
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7
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Ward V, Freeman S, Callander T, Xiong B. Professional experiences of formal healthcare providers in the provision of medical assistance in dying (MAiD): A scoping review. Palliat Support Care 2021; 19:744-758. [PMID: 33781368 DOI: 10.1017/s1478951521000146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This scoping review describes the existing literature which examines the breadth of healthcare providers' (HCP's) experiences with the provision of medical assistance in dying (MAiD). METHOD This study employed a scoping review methodology: (1) identify research articles, (2) identify relevant studies, (3) select studies based on inclusion/exclusion criteria, (4) chart the data, and (5) summarize the results. RESULTS In total, 30 papers were identified pertaining to HCP's experiences of providing MAiD. Fifty-three percent of the papers were from Europe (n = 16) and 40% of studies were from the USA or Canada (n = 12). The most common participant populations were physicians (n = 17) and nurses (n = 12). This scoping review found that HCPs experienced a variety of emotional responses to providing or providing support to MAiD. Some HCPs experienced positive emotions through helping patients at the end of the patient's life. Still other HCPs experienced very intense and negative emotions such as immense internal moral conflict. HCPs from various professions were involved in various aspects of MAiD provision such as responding to initial requests for MAiD, supporting patients and families, nursing support during MAiD, and the administration of medications to end of life. SIGNIFICANCE OF RESULTS This review consolidates many of the experiences of HCPs in relation to the provision of MAiD. Specifically, this review elucidates many of the emotions that HCPs experience through participation in MAiD. In addition to describing the emotional experiences, this review highlights some of the roles that HCPs participate in with relation to MAiD. Finally, this review accentuates the importance of team supports and self-care for all team members in the provision of MAiD regardless of their degree of involvement.
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Affiliation(s)
- Valerie Ward
- Northern Medical Program, University of Northern British Columbia, Prince George, BC, Canada
| | - Shannon Freeman
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Taylor Callander
- Northern Medical Program, University of Northern British Columbia, Prince George, BC, Canada
| | - Beibei Xiong
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
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8
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Hewitt J, White B, Villar KD, Willmott L, Greaves LL, Meehan R. Voluntary assisted dying in Victoria: Why knowing the law matters to nurses. Nurs Ethics 2020; 28:221-229. [PMID: 32873123 DOI: 10.1177/0969733020944457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2017, Victoria became the first state in Australia to pass legislation permitting voluntary assisted dying. Under this law, only those people who are near the end of their lives may access voluntary assisted dying, and because many of these people require nursing care to manage the progression of their illness or their symptoms, it will invariably have an impact on nursing practice. The Victorian law includes a series of procedural steps as safeguards to ensure that the law operates as intended. To support people who choose voluntary assisted dying and to practice safely within boundaries of the law, nurses must be aware of these requirements and how they operate. However, there are often gaps in nurses' legal knowledge. This was demonstrated in an article that aimed to inform nurses about the operation of Voluntary Assisted Dying Act 2017 (Vic) but contained several errors and misstatements of the law. Our article corrects these errors and discusses how the law is intended to be applied by revisiting the fictional case of Chloe - a woman with a terminal illness who is seeking voluntary assisted dying. As the Voluntary Assisted Dying Act 2017 (Vic) also protects nurses from liability if they act in accordance with its provisions, we conclude that sound knowledge and understanding of its operation support nurses to provide the safe, comprehensive and compassionate care their patients deserve at the end of life.
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Pesut B, Thorne S, Greig M, Fulton A, Janke R, Vis-Dunbar M. Ethical, Policy, and Practice Implications of Nurses' Experiences With Assisted Death: A Synthesis. ANS Adv Nurs Sci 2020; 42:216-230. [PMID: 31335329 PMCID: PMC6686960 DOI: 10.1097/ans.0000000000000276] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The conceptualization of assisted death as an act performed by physicians has resulted in a lack of attention to nurses' roles and experiences with the processes that surround an assisted death. In this article, we synthesize evidence from 6 articles focusing on the experiences of 55 nurses from Canada, Belgium, and the Netherlands, with relevant ethical and policy implications derived from the literature. Nurses have a central role in negotiating inquiries about assisted death and in providing wraparound care for patients, families, and other health care providers. This role is impactful for nurses and requires significant personal and professional moral work.
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Affiliation(s)
- Barbara Pesut
- University of British Columbia, Okanagan, Kelowna (Dr Pesut, Ms Greig, and Messrs Fulton, Janke, and Vis-Dunbar) and University of British Columbia, Vancouver (Dr Thorne), British Columbia, Canada
| | - Sally Thorne
- University of British Columbia, Okanagan, Kelowna (Dr Pesut, Ms Greig, and Messrs Fulton, Janke, and Vis-Dunbar) and University of British Columbia, Vancouver (Dr Thorne), British Columbia, Canada
| | - Madeleine Greig
- University of British Columbia, Okanagan, Kelowna (Dr Pesut, Ms Greig, and Messrs Fulton, Janke, and Vis-Dunbar) and University of British Columbia, Vancouver (Dr Thorne), British Columbia, Canada
| | - Adam Fulton
- University of British Columbia, Okanagan, Kelowna (Dr Pesut, Ms Greig, and Messrs Fulton, Janke, and Vis-Dunbar) and University of British Columbia, Vancouver (Dr Thorne), British Columbia, Canada
| | - Robert Janke
- University of British Columbia, Okanagan, Kelowna (Dr Pesut, Ms Greig, and Messrs Fulton, Janke, and Vis-Dunbar) and University of British Columbia, Vancouver (Dr Thorne), British Columbia, Canada
| | - Mathew Vis-Dunbar
- University of British Columbia, Okanagan, Kelowna (Dr Pesut, Ms Greig, and Messrs Fulton, Janke, and Vis-Dunbar) and University of British Columbia, Vancouver (Dr Thorne), British Columbia, Canada
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10
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Pesut B, Thorne S, Storch J, Chambaere K, Greig M, Burgess M. Riding an elephant: A qualitative study of nurses' moral journeys in the context of Medical Assistance in Dying (MAiD). J Clin Nurs 2020; 29:3870-3881. [PMID: 32700402 PMCID: PMC7540490 DOI: 10.1111/jocn.15427] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/27/2020] [Accepted: 07/03/2020] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To describes nurses' moral experiences with Medical Assistance in Dying in the Canadian context. BACKGROUND Nurses perform important roles in Medical Assistance in Dying in Canada and do so within a unique context in which Medical Assistance in Dying is provided through healthcare services and where accessibility is an important principle. International literature indicates that participating in Medical Assistance in Dying can be deeply impactful for nurses and requires a high degree of moral sense-making. DESIGN A qualitative interview study guided by Interpretive Description using the COREQ checklist. RESULTS Fifty-nine nurses from across Canada participated in the study. The decision to participate in Medical Assistance in Dying was influenced by family and community, professional experience and nurses' proximity to the act of Medical Assistance in Dying. Nurses described a range of deep and sometimes conflicting emotional reactions provoked by Medical Assistance in Dying. Nurses used a number of moral waypoints to make sense of their decision including patient choice, control and certainty; an understanding that it was not about the nurse; a commitment to staying with patients through suffering; consideration of moral consistency; issues related to the afterlife; and the peace and gratitude demonstrated by patients and families. DISCUSSION The depth of nurses' intuitional moral responses and their need to make sense of these responses are consistent with Haidt's theory of moral experience in which individuals use reasoning primarily to explain their moral intuition and in which moral change occurs primarily through compassionate social interaction. Further, work on the moral identity of nursing provides robust explanation of how nurses' moral decisions are contextually and relationally mediated and how they seek to guard patient vulnerability, even at their own emotional cost. CONCLUSION Medical Assistance in Dying is impactful for nurses, and for some, it requires intensive and ongoing moral sense-making. RELEVANCE TO CLINICAL PRACTICE There is a need to provide support for nurses' moral deliberation and emotional well-being in the context of Medical Assistance in Dying care.
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Affiliation(s)
- Barbara Pesut
- University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Sally Thorne
- University of British Columbia, Vancouver, BC, Canada
| | | | - Kenneth Chambaere
- Ghent University, Ghent, Belgium.,Vrije Universeteit Brussel (VUB), Brussels, Belgium
| | - Madeleine Greig
- University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Michael Burgess
- University of British Columbia, Okanagan, Kelowna, BC, Canada
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11
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Patel T, Christy K, Grierson L, Shadd J, Farag A, O'Toole D, Lawson J, Vanstone M. Clinician responses to legal requests for hastened death: a systematic review and meta-synthesis of qualitative research. BMJ Support Palliat Care 2020; 11:59-67. [PMID: 32601150 DOI: 10.1136/bmjspcare-2019-002018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The legalisation of medical assistance in dying in numerous countries over the last 20 years represents a significant shift in practice and scope for many clinicians who have had little-to-no training to prepare them to sensitively respond to patient requests for hastened death. AIMS Our objective was to review the existing qualitative literature on the experiences of healthcare providers responding to requests for hastened death with the aim of answering the question: how do clinicians make sense of, and respond to patients' expressed wishes for hastened death? METHODS We performed a systematic review and meta-synthesis of primary qualitative research articles that described the experiences and perspectives of healthcare professionals who have responded to requests for hastened death in jurisdictions where MAiD (Medical Assistance in Dying) was legal or depenalised. A staged coding process was used to identify and analyse core themes. RESULTS Although the response to requests for hastened death varied case-by-case, clinicians formulated their responses by considering seven distinct domains. These include: policies, professional identity, commitment to patient autonomy, personal values and beliefs, the patient-clinician relationship, the request for hastened death and the clinician's emotional and psychological response. CONCLUSION Responding to a request for hastened death can be an overwhelming task for clinicians. An approach that takes into consideration the legal, personal, professional and patient perspectives is required to provide a response that encompasses all the complexities associated with such a monumental request.
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Affiliation(s)
- Tejal Patel
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kayonne Christy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Grierson
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joshua Shadd
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Farag
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Danielle O'Toole
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Lawson
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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12
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Variath C, Peter E, Cranley L, Godkin D, Just D. Relational influences on experiences with assisted dying: A scoping review. Nurs Ethics 2020; 27:1501-1516. [PMID: 32436431 DOI: 10.1177/0969733020921493] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Family members and healthcare providers play an integral role in a person's assisted dying journey. Their own needs during the assisted dying journey are often, however, unrecognized and underrepresented in policies and guidelines. Circumstances under which people choose assisted dying, and relational contexts such as the sociopolitical environment, may influence the experiences of family members and healthcare providers. ETHICAL CONSIDERATIONS Ethics approval was not required to conduct this review. AIM This scoping review aims to identify the relational influences on the experiences of family members and healthcare providers of adults who underwent assisted dying and of those unable to access assisted dying due to the loss of capacity to consent. METHODS A literature search was conducted in four databases, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. The search retrieved 12,074 articles, a number narrowed down to 172 articles for full-text screening. Thirty-six articles met the established inclusion criteria. A feminist relational framework guided the data analysis. RESULTS Five key themes on the influences of family members' and healthcare providers' experiences throughout the assisted dying process were synthesized from the data. They include (1) relationships as central to beginning the process, (2) social and political influences on decision making, (3) complex roles and responsibilities of family members and healthcare providers, (4) a unique experience of death, and (5) varying experiences following death. CONCLUSION The feminist relational lens, used to guide analysis, shed light on the effect of the sociopolitical influences and the relationships among patients, families, and healthcare providers on each other's experiences. Addressing the needs of the family members and healthcare providers is vital to improving the assisted dying process. Including families' and healthcare providers' needs within institutional policies and enhancing collaboration and communication among those involved could improve the overall experience.
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Pesut B, Thorne S, Schiller CJ, Greig M, Roussel J. The rocks and hard places of MAiD: a qualitative study of nursing practice in the context of legislated assisted death. BMC Nurs 2020; 19:12. [PMID: 32095114 PMCID: PMC7025406 DOI: 10.1186/s12912-020-0404-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background Medical Assistance in Dying (MAiD) was legalized in Canada in June, 2016. The Canadian government's decision to legislate assisted dying, an approach that requires a high degree of obligation, precision, and delegation, has resulted in unique challenges for health care and for nursing practice. The purpose of this study was to better understand the implications of a legislated approach to assisted death for nurses' experiences and nursing practice. Methods The study used a qualitative approach guided by Interpretive Description. Semi-structured interviews were conducted with 59 registered nurses and nurse practitioners. Interviews were audio-recorded, transcribed, and managed using qualitative analysis software. Analysis followed a procedure of data immersion, open coding, constant comparative analysis, and the construction of a thematic and interpretive account. Results Nurses in this study described great variability in how MAiD had been enacted in their work context and the practice supports available to guide their practice. The development of systems to support MAiD, or lack thereof, was largely driven by persons in influential leadership positions. Workplaces that supported a range of nurses' moral responses to MAiD were most effective in supporting nurses' well-being during this impactful change in practice. Participants cited the importance of teamwork in providing high quality MAiD-related care; although, many worked without the benefit of a team. Nursing work related to MAiD was highly complex, largely because of the need for patient-centered care in systems that were not always organized to support such care. In the absence of adequate practice supports, some nurses were choosing to limit their involvement in MAiD. Conclusions Data obtained in this study suggested that some workplace contexts still lack the necessary supports for nurses to confidently meet the precision required of a legislated approach to MAiD. Without accessible palliative care, sufficient providers, a supportive team, practice supports, and a context that allowed nurses to have a range of responses to MAiD, nurses felt they were legally and morally at risk. Nurses seeking to provide the compassionate care consistent with such a momentous moment in patients' lives, without suitable supports, find themselves caught between the proverbial rock and hard place.
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Affiliation(s)
- Barbara Pesut
- 1Canada Research Chair in Health, Ethics, and Diversity, University of British Columbia Okanagan, 1147 Research Road, Okanagan, Kelowna, BC V1V 1V7 Canada
| | - Sally Thorne
- 2University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | | | - Madeleine Greig
- 1Canada Research Chair in Health, Ethics, and Diversity, University of British Columbia Okanagan, 1147 Research Road, Okanagan, Kelowna, BC V1V 1V7 Canada
| | - Josette Roussel
- 4Policy, Advocacy and Strategy, Canadian Nurses Association, 50 Driveway, Ottawa, Ontario K2P 1E2 Canada
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Pesut B, Thorne S, Schiller C, Greig M, Roussel J, Tishelman C. Constructing Good Nursing Practice for Medical Assistance in Dying in Canada: An Interpretive Descriptive Study. Glob Qual Nurs Res 2020; 7:2333393620938686. [PMID: 32743024 PMCID: PMC7377599 DOI: 10.1177/2333393620938686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Nurses play a central role in Medical Assistance in Dying (MAiD) in Canada. However, we know little about nurses' experiences with this new end-of-life option. The purpose of this study was to explore how nurses construct good nursing practice in the context of MAiD. This was a qualitative interview study using Interpretive Description. Fifty-nine nurses participated in semi-structured telephone interviews. Data were analyzed inductively. The findings illustrated the ways in which nurses constructed artful practice to humanize what was otherwise a medicalized event. Registered nurses and nurse practitioners described creating a person-centered MAiD process that included establishing relationship, planning meticulously, orchestrating the MAiD death, and supporting the family. Nurses in this study illustrated how a nursing gaze focused on relationality crosses the moral divides that characterize MAiD. These findings provide an in-depth look at what constitutes good nursing practice in MAiD that can support the development of best practices.
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Affiliation(s)
- Barbara Pesut
- The University of British Columbia,
Kelowna, British Columbia, Canada
| | - Sally Thorne
- The University of British Columbia,
Vancouver, British Columbia, Canada
| | - Catharine Schiller
- University of Northern British Columbia,
Prince George, British Columbia, Canada
| | - Madeleine Greig
- The University of British Columbia,
Kelowna, British Columbia, Canada
| | | | - Carol Tishelman
- Karolinska Institute, Stockholm,
Sweden
- Stockholm Health Care Services,
Stockholm, Sweden
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Bellens M, Debien E, Claessens F, Gastmans C, Dierckx de Casterlé B. “It is still intense and not unambiguous.” Nurses' experiences in the euthanasia care process 15 years after legalisation. J Clin Nurs 2019; 29:492-502. [DOI: 10.1111/jocn.15110] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/22/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Marthe Bellens
- Department of Public Health and Primary Care Academic Centre for Nursing and Midwifery KU Leuven Leuven Belgium
| | - Elisa Debien
- Department of Public Health and Primary Care Academic Centre for Nursing and Midwifery KU Leuven Leuven Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy KU Leuven Leuven Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law KU Leuven Leuven Belgium
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Pesut B, Thorne S, Stager ML, Schiller CJ, Penney C, Hoffman C, Greig M, Roussel J. Medical Assistance in Dying: A Review of Canadian Nursing Regulatory Documents. Policy Polit Nurs Pract 2019; 20:113-130. [PMID: 31060478 PMCID: PMC6827351 DOI: 10.1177/1527154419845407] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Canada's legalization of Medical Assistance in Dying (MAiD) in 2016 has had important implications for nursing regulators. Evidence indicates that registered nurses perform key roles in ensuring high-quality care for patients receiving MAiD. Further, Canada is the first country to recognize nurse practitioners as MAiD assessors and providers. The purpose of this article is to analyze the documents created by Canadian nursing regulatory bodies to support registered nurse and nurse practitioner practice in the political context of MAiD. A search of Canadian provincial and territorial websites retrieved 17 documents that provided regulatory guidance for registered nurses and nurse practitioners related to MAiD. Responsibilities of registered nurses varied across all documents reviewed but included assisting in assessment of patient competency, providing information about MAiD to patients and families, coordinating the MAiD process, preparing equipment and intravenous access for medication delivery, coordinating and informing health care personnel related to the MAiD procedure, documenting nursing care provided, supporting patients and significant others, and providing post death care. Responsibilities of nurse practitioners were identified in relation to existing legislation. Safety concerns cited in these documents related to ensuring that nurses understood their boundaries in relation to counseling versus informing, administering versus aiding, ensuring safeguards were met, obtaining informed consent, and documenting. Guidance related to conscientious objection figured prominently across documents. These findings have important implications for system level support for the nursing role in MAiD including ongoing education and support for nurses' moral decision making.
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Affiliation(s)
- Barbara Pesut
- School of Nursing and Health, Ethics, and Diversity Lab, University of British Columbia, Kelowna, BC, Canada
| | - Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Catharine J Schiller
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Christine Penney
- Regulatory Policy, British Columbia College of Nursing Professionals, Vancouver, BC, Canada
| | - Carolyn Hoffman
- Institute for Safe Medication Practices Canada, Toronto, ON, Canada
| | | | - Josette Roussel
- Nursing Practice and Policy, Canadian Nurses Association, Ottawa, ON, Canada
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17
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Health Care Provider Experiences of and Perspectives on Medical Assistance in Dying: A Scoping Review of Qualitative Studies. Can J Aging 2019; 38:384-396. [PMID: 30626453 DOI: 10.1017/s0714980818000600] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
ABSTRACTMuch of the literature on health care provider perspectives on medical assistance in dying (MAiD) is focused on the role of the physician, with some literature examining the views of nurses. Some Canadian provinces however, have implemented multidisciplinary approaches to MAiD. As a result, an improved understanding of the experiences of a variety of health care providers in the MAiD process will be important to consider as provincial MAiD plans continue to develop. This scoping review aimed to summarize the existing qualitative literature focused on provider experiences in the MAiD process. Key themes emerged across the literature that were related to the complexity of the MAiD process, the importance of relationships and communication, interprofessional roles and dynamics, and the coping process. The results of this review demonstrate the need for further investigation into the experiences of diverse MAiD providers, especially within the Canadian context.
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Elmore J, Wright DK, Paradis M. Nurses’ moral experiences of assisted death: A meta-synthesis of qualitative research. Nurs Ethics 2016; 25:955-972. [DOI: 10.1177/0969733016679468] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is (1) defined by a profound sense of responsibility, (2) shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and (3) sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded.
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Affiliation(s)
- James Elmore
- St. Mary’s Research Centre, Canada; McGill University, Canada
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19
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Van Humbeeck L, Dillen L, Piers R, Van Den Noortgate N. Grief and loss in older people residing in nursing homes: (un)detected by nurses and care-assistants? J Adv Nurs 2016; 72:3125-3136. [DOI: 10.1111/jan.13063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - Let Dillen
- Department of Geriatric Medicine; Ghent University Hospital; Ghent Belgium
| | - Ruth Piers
- Department of Geriatric Medicine; Ghent University Hospital; Ghent Belgium
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20
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Attitudes of Psychiatric Nurses about the Request for Euthanasia on the Basis of Unbearable Mental Suffering(UMS). PLoS One 2015; 10:e0144749. [PMID: 26700007 PMCID: PMC4689522 DOI: 10.1371/journal.pone.0144749] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION When psychiatric patients express a wish for euthanasia, this should first and foremost be interpreted as a cry for help. Due to their close day-to-day relationship, psychiatric nurses may play an important and central role in responding to such requests. However, little is known about nurses' attitudes towards euthanasia motivated by unbearable mental suffering. OBJECTIVES The aim of this study was to provide insight into the attitudes and actions taken by psychiatric nurses when confronted with a patient's euthanasia request based on unbearable mental suffering (UMS). METHOD A questionnaire was sent to 11 psychiatric hospitals in the Flemish part of Belgium. RESULTS The overall response rate was 70% (N = 627). Psychiatric nurses were frequently confronted with a request for euthanasia, either directly (N = 329, 53%) or through a colleague (N = 427, 69%). A majority (N = 536, 84%) did not object to euthanasia in a psychiatrically ill population with UMS. Confounding factors were the psychiatric diagnosis and the type of ward where the nurses were working. Most participants acknowledged a lack of knowledge and skills to adequately address the euthanasia request (N = 434, 71%). Nearly unanimously (N = 618, 99%), study participants indicated that dealing with euthanasia requests and other end-of-life issues should be part of the formal training of nurses. CONCLUSION The results highlight the need for ethically sound and comprehensive provision of care. Psychiatric nurses play an important role in dealing with the complex issue of requests for euthanasia. There is also a need for education, training and clear guidelines on the level of health care organizations.
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Woods M, Bickley Asher J. Nurses and the euthanasia debate: reflections from New Zealand. Int Nurs Rev 2014; 62:13-20. [DOI: 10.1111/inr.12145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. Woods
- School of Nursing; Massey University; Palmerston North New Zealand
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22
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Andrew EVW, Cohen J, Evans N, Meñaca A, Harding R, Higginson I, Pool R, Gysels M. Social-cultural factors in end-of-life care in Belgium: a scoping of the research literature. Palliat Med 2013; 27:131-43. [PMID: 22143040 DOI: 10.1177/0269216311429619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As end-of-life (EoL) care expands across Europe and the world, service developments are increasingly studied. The sociocultural context in which such changes take place, however, is often neglected in research. AIM To explore sociocultural factors in EoL care in Belgium as represented by the literature. DESIGN A scoping of the empirical research literature following a systematic search procedure with a focus on thematic analysis based on the literature findings. DATA SOURCES Searches were carried out in eight electronic databases, five journals, reference lists, and grey literature (through September 2010). Articles informing about sociocultural issues in EoL care were included. RESULTS One hundred and fifteen original studies met the inclusion criteria, the majority (107) published between 2000 and 2010. Four major themes were: Setting; Caregivers; Communication; and Medical EoL Decisions (the largest category). Minority Ethnic Groups was an emerging theme. Gaps included: research in Wallonia and Brussels; the role and experiences of informal caregivers; issues of access to palliative care; and experiences of minority ethnic groups. There was a paucity of in-depth qualitative studies. CONCLUSIONS Various sociocultural factors influence the provision of EoL care in Belgium. This country provides a unique opportunity to witness how euthanasia is put into practice when legalized, in a context where palliative care is also highly developed and where many health care institutions have Catholic affiliation, providing an important example to others. Attention to how the sociocultural context affects EoL care adds to the current evidence base of service provision, which is essential in the further development of EoL care.
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Affiliation(s)
- Erin V W Andrew
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic - Universitat de Barcelona), Barcelona, Spain.
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23
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Gysels M, Evans N, Meñaca A, Andrew E, Toscani F, Finetti S, Pasman HR, Higginson I, Harding R, Pool R. Culture and end of life care: a scoping exercise in seven European countries. PLoS One 2012; 7:e34188. [PMID: 22509278 PMCID: PMC3317929 DOI: 10.1371/journal.pone.0034188] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/28/2012] [Indexed: 11/18/2022] Open
Abstract
AIM Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. METHODS We scoped the literature for Germany, Norway, Belgium, The Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. RESULTS A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. CONCLUSION This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL care in the future.
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Affiliation(s)
- Marjolein Gysels
- Barcelona Centre for International Health Research, Universitat de Barcelona, Barcelona, Spain.
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Dierckx de Casterlé B, Gastmans C, Bryon E, Denier Y. QUAGOL: A guide for qualitative data analysis. Int J Nurs Stud 2012; 49:360-71. [PMID: 21996649 DOI: 10.1016/j.ijnurstu.2011.09.012] [Citation(s) in RCA: 361] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 09/14/2011] [Accepted: 09/16/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Bernadette Dierckx de Casterlé
- Centre of Health Services and Nursing Research, Faculty of Medicine, Catholic University of Leuven, Kapucijnenvoer 35 blok d - bus 7001, 3000 Leuven, Belgium.
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