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Published in: Journal of General Internal Medicine 4/2022

01-03-2022 | Care | Original Research

A Race to the End: Family Caregivers’ Experience of Medical Assistance in Dying (MAiD)—a Qualitative Study

Authors: Tharshika Thangarasa, MD, Sarah Hales, MD PhD, Eryn Tong, MSc, Ekaterina An, MSc, Debbie Selby, MD, Elie Isenberg-Grzeda, MD, Madeline Li, MD PhD, Gary Rodin, MD, Sally Bean, JD MA, Jennifer A. H. Bell, BA MA PhD, Rinat Nissim, PhD

Published in: Journal of General Internal Medicine | Issue 4/2022

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Abstract

Background

The June 2016 legalization of medical assistance in dying (MAiD) provided an added layer of choice to end-of-life care in Canada. Family caregivers play an important role in patient end-of-life decision-making. They may experience unique psychological burden or distress associated with their role. However, we know little about the caregiver experience associated with patient MAiD requests and the nature of psychosocial supports caregivers require before, during, and following MAiD intervention.

Objective

The objective of this study is to better understand the caregiver experience of MAiD within the Canadian legal landscape following Bill C-14.

Design

Caregiver experience was examined based on qualitative, semi-structured interviews.

Participants

A total of 22 caregivers of patients who had requested MAiD were interviewed.

Approach

Transcripts were recorded, transcribed, and analyzed based on grounded theory methodology.

Key Results

The caregiver experience of MAiD within the legal framework was found to be understood as a “race to the end,” with the ultimate goal of creating an ideal dying experience for the patient while balancing a threat to capacity that would undermine their access to MAiD. Caregivers can be described within the overarching framework as either co-runners or onlookers. Sources of caregiver distress were linked to these roles.

Conclusions

The “race to the end” theoretical model contributes new knowledge and understanding that can inform the development of tailored support services for caregivers, the impact of legislative changes on this population, and future research examining decision-making near end of life and the caregiver experience.
Literature
2.
go back to reference Romito F, Goldzweig G, Cormio C, Hagedoorn M, Andersen BL. Informal caregiving for cancer patients. Cancer. 2013 Jun 1;119:2160-9.CrossRef Romito F, Goldzweig G, Cormio C, Hagedoorn M, Andersen BL. Informal caregiving for cancer patients. Cancer. 2013 Jun 1;119:2160-9.CrossRef
3.
go back to reference Braun M, Mikulincer M, Rydall A, Walsh A, Rodin G. Hidden morbidity in cancer: spouse caregivers. J Clin Oncol. 2007 Oct 20;25(30):4829-4834.CrossRef Braun M, Mikulincer M, Rydall A, Walsh A, Rodin G. Hidden morbidity in cancer: spouse caregivers. J Clin Oncol. 2007 Oct 20;25(30):4829-4834.CrossRef
4.
go back to reference Haun MW, Sklenarova H, Brechtel A, Herzog W, Hartmann M. Distress in cancer patients and their caregivers and association with the caregivers' perception of dyadic communication. Oncology research and treatment. 2014;37(7-8):384-8.CrossRef Haun MW, Sklenarova H, Brechtel A, Herzog W, Hartmann M. Distress in cancer patients and their caregivers and association with the caregivers' perception of dyadic communication. Oncology research and treatment. 2014;37(7-8):384-8.CrossRef
5.
go back to reference Beesley VL, Price MA, Webb PM. Loss of lifestyle: health behaviour and weight changes after becoming a caregiver of a family member diagnosed with ovarian cancer. Supportive Care in Cancer. 2011 Dec;19(12):1949-56.CrossRef Beesley VL, Price MA, Webb PM. Loss of lifestyle: health behaviour and weight changes after becoming a caregiver of a family member diagnosed with ovarian cancer. Supportive Care in Cancer. 2011 Dec;19(12):1949-56.CrossRef
6.
go back to reference Edwards B, Clarke V. The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients' illness characteristics on depression and anxiety Psycho-Oncology. Journal of the Psychological, Social and Behavioral Dimensions of Cancer. 2004 Aug;13(8):562-76. Edwards B, Clarke V. The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients' illness characteristics on depression and anxiety Psycho-Oncology. Journal of the Psychological, Social and Behavioral Dimensions of Cancer. 2004 Aug;13(8):562-76.
7.
go back to reference Lewis FM, Fletcher KA, Cochrane BB, Fann JR. Predictors of depressed mood in spouses of women with breast cancer. Journal of Clinical Oncology. 2008 Mar 10;26(8):1289-95.CrossRef Lewis FM, Fletcher KA, Cochrane BB, Fann JR. Predictors of depressed mood in spouses of women with breast cancer. Journal of Clinical Oncology. 2008 Mar 10;26(8):1289-95.CrossRef
8.
go back to reference Nissim R, Hales S, Zimmermann C, Deckert A, Edwards B, Rodin G. Supporting family caregivers of advanced cancer patients: a focus group study. Fam Relat. 2017 Dec;66(5):867-79.CrossRef Nissim R, Hales S, Zimmermann C, Deckert A, Edwards B, Rodin G. Supporting family caregivers of advanced cancer patients: a focus group study. Fam Relat. 2017 Dec;66(5):867-79.CrossRef
9.
go back to reference Snijdewind MC, van Tol DG, Onwuteaka-Philipsen BD, Willems DL. Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients' relatives. J Pain Symptom Manage. 2014 Dec 1;48(6):1125-34.CrossRef Snijdewind MC, van Tol DG, Onwuteaka-Philipsen BD, Willems DL. Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients' relatives. J Pain Symptom Manage. 2014 Dec 1;48(6):1125-34.CrossRef
10.
go back to reference Georges JJ, Onwuteaka-Philipsen BD, Muller MT, Van der Wal G, Van der Heide A, Van der Maas PJ. Relatives’ perspective on the terminally ill patients who died after euthanasia or physician-assisted suicide: a retrospective cross-sectional interview study in the Netherlands. Death Stud. 2007 Jan 1;31(1):1-5.CrossRef Georges JJ, Onwuteaka-Philipsen BD, Muller MT, Van der Wal G, Van der Heide A, Van der Maas PJ. Relatives’ perspective on the terminally ill patients who died after euthanasia or physician-assisted suicide: a retrospective cross-sectional interview study in the Netherlands. Death Stud. 2007 Jan 1;31(1):1-5.CrossRef
11.
go back to reference Hendry M, Pasterfield D, Lewis R, Carter B, Hodgson D, Wilkinson C. Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying. Palliat Med. 2013 Jan;27(1):13-26.CrossRef Hendry M, Pasterfield D, Lewis R, Carter B, Hodgson D, Wilkinson C. Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying. Palliat Med. 2013 Jan;27(1):13-26.CrossRef
12.
go back to reference Goldberg R, Nissim R, An E, Hales S. Impact of medical assistance in dying (MAiD) on family caregivers. BMJ Support Palliat Care. 2019 Mar 2:bmjspcare-2018. Goldberg R, Nissim R, An E, Hales S. Impact of medical assistance in dying (MAiD) on family caregivers. BMJ Support Palliat Care. 2019 Mar 2:bmjspcare-2018.
13.
go back to reference Glaser BG, Strauss AL. The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine; 1967. Glaser BG, Strauss AL. The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine; 1967.
14.
go back to reference Rennie D, Nissim R. The Grounded Theory Method and Humanistic Psychology. In: Schneider K, Pierson J, Bugental J, editors. The Handbook of Humanistic Psychology: Leading Edges in Theory, Practice, and Research. 2nd ed. Thousand Oaks: Sage; 2015. p. 297-308. Rennie D, Nissim R. The Grounded Theory Method and Humanistic Psychology. In: Schneider K, Pierson J, Bugental J, editors. The Handbook of Humanistic Psychology: Leading Edges in Theory, Practice, and Research. 2nd ed. Thousand Oaks: Sage; 2015. p. 297-308.
15.
go back to reference Holmes S, Wiebe E, Shaw J, Nuhn A, Just A, Kelly M. Exploring the experience of supporting a loved one through a medically assisted death in Canada. Can Fam Physician. 2018 Sep 1;64(9):e387-93.PubMedPubMedCentral Holmes S, Wiebe E, Shaw J, Nuhn A, Just A, Kelly M. Exploring the experience of supporting a loved one through a medically assisted death in Canada. Can Fam Physician. 2018 Sep 1;64(9):e387-93.PubMedPubMedCentral
16.
go back to reference Hand LC, Thomas TH, Belcher S et al. Caregiving Is a Marathon, Not a Road Race: Reenvisioning Caregiver Support Services in Gynecologic Oncology. Int J Gynaecol Obstet. 2018 Nov 1;28(9):1722-7. Hand LC, Thomas TH, Belcher S et al. Caregiving Is a Marathon, Not a Road Race: Reenvisioning Caregiver Support Services in Gynecologic Oncology. Int J Gynaecol Obstet. 2018 Nov 1;28(9):1722-7.
18.
go back to reference Gamondi C, Pott M, Preston N, Payne S. Family caregivers’ reflections on experiences of assisted suicide in Switzerland: a qualitative interview study. J Pain Symptom Manage. 2018 Apr 1;55(4):1085-94.CrossRef Gamondi C, Pott M, Preston N, Payne S. Family caregivers’ reflections on experiences of assisted suicide in Switzerland: a qualitative interview study. J Pain Symptom Manage. 2018 Apr 1;55(4):1085-94.CrossRef
19.
go back to reference Gamondi C, Pott M, Forbes K, Payne S. Exploring the experiences of bereaved families involved in assisted suicide in Southern Switzerland: a qualitative study. BMJ Support Palliat Care. 2015 Jun 1;5(2):146-52.CrossRef Gamondi C, Pott M, Forbes K, Payne S. Exploring the experiences of bereaved families involved in assisted suicide in Southern Switzerland: a qualitative study. BMJ Support Palliat Care. 2015 Jun 1;5(2):146-52.CrossRef
20.
go back to reference Lowers J, Scardaville M, Hughes S, Preston NJ. Comparison of the experience of caregiving at end of life or in hastened death: a narrative synthesis review. BMC Palliative Care. 2020 Dec;19(1):1-6.CrossRef Lowers J, Scardaville M, Hughes S, Preston NJ. Comparison of the experience of caregiving at end of life or in hastened death: a narrative synthesis review. BMC Palliative Care. 2020 Dec;19(1):1-6.CrossRef
21.
go back to reference Ganzini L, Goy ER, Dobscha SK, Prigerson H. Mental health outcomes of family members of Oregonians who request physician aid in dying. Journal of pain and symptom management. 2009 Dec 1;38(6):807-15.CrossRef Ganzini L, Goy ER, Dobscha SK, Prigerson H. Mental health outcomes of family members of Oregonians who request physician aid in dying. Journal of pain and symptom management. 2009 Dec 1;38(6):807-15.CrossRef
22.
go back to reference Downar J, Fowler RA, Halko R, Huyer LD, Hill AD, Gibson JL. Early experience with medical assistance in dying in Ontario, Canada: a cohort study. CMAJ. 2020 Feb 24;192(8):e173-81.CrossRef Downar J, Fowler RA, Halko R, Huyer LD, Hill AD, Gibson JL. Early experience with medical assistance in dying in Ontario, Canada: a cohort study. CMAJ. 2020 Feb 24;192(8):e173-81.CrossRef
23.
go back to reference Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005 Apr 28;330(7498):1007-11.CrossRef Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005 Apr 28;330(7498):1007-11.CrossRef
Metadata
Title
A Race to the End: Family Caregivers’ Experience of Medical Assistance in Dying (MAiD)—a Qualitative Study
Authors
Tharshika Thangarasa, MD
Sarah Hales, MD PhD
Eryn Tong, MSc
Ekaterina An, MSc
Debbie Selby, MD
Elie Isenberg-Grzeda, MD
Madeline Li, MD PhD
Gary Rodin, MD
Sally Bean, JD MA
Jennifer A. H. Bell, BA MA PhD
Rinat Nissim, PhD
Publication date
01-03-2022
Publisher
Springer International Publishing
Keyword
Care
Published in
Journal of General Internal Medicine / Issue 4/2022
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-021-07012-z

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