Living fully, choosing wisely: Exploring patient-centred approaches to palliative care and MAiD – Part II, the role of the oncology nurse
Abstract
This paper is Part II of a case study that follows Nancy, an oncology patient, through her diagnosis of advanced cancer, involvement of early palliative care (EPC), and consideration of Medical Assistance in Dying (MAiD), and her oncology nurse, Laura. Highlighted is the importance of open communication, emotional support, and involvement of the patient’s family in the process, to the level that is acceptable to the individual seeking or considering MAiD. The paper also addresses the ethical considerations for nurses when personal beliefs conflict with professional responsibilities. Practical insights and suggestions for oncology nurses are offered for promoting a compassionate and respectful approach to end-of-life care.
DOI: 10.5737/23688076356858
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Banerjee, S. C., Manna, R., Coyle, N., Shen, M. J., Pehrson, C., Zaider, T., Hammonds, S., Krueger, C. A., Parker, P. A., & Bylund, C. L. (2016). Oncology nurses’ communication challenges with patients and families: A qualitative study. Nurse Education in Practice, 16(1), 193–201. https://doi.org/10.1016/j.nepr.2015.07.007
Blaževi?ien?, A., Newland, J. A., ?ivinskien?, V., & Beckstrand, R. L. (2017). Oncology nurses’ perceptions of obstacles and role at the end-of-life care: Cross-sectional survey. BMC Palliative Care, 16(1), 74. https://doi.org/10.1186/s12904-017-0257-1
Beuthin, R., Bruce, A., & Scaia, M. (2018). Medical assistance in dying (MAiD): Canadian nurses’ experiences. Nursing Forum, 53(4), 511–520. https://doi.org/10.1111/nuf.12280
Bill C-7. (2021). An Act to amend the Criminal Code (medical assistance in dying). Government of Canada. https://parl.ca/DocumentViewer/en/43-2/bill/C-7/royal-assent
Bill C-14. (2016). An Act to amend the Criminal Code and to make related amendments to other acts (medical assistance in dying), RSC 2016, c 3. [Revised September 27, 2018.] Government of Canada. https://lop.parl.ca/staticfiles/PublicWebsite/Home/ResearchPublications/LegislativeSummaries/PDF/42-1/c14-e.pdf
Brown, J., Goodridge, D., Harrison, A., Kemp, J., Thorpe, L., & Weiler, R. (2020a). Care considerations in a patient- and family-centred medical assistance in dying program. Journal of Palliative Care, 37(3), 341–351. https://doi.org/10.1177/0825859720951661
Brown, J., Goodridge, D., Harrison, A., Kemp, J., Thorpe, L., & Weiler, R. (2020b). Medical assistance in dying: Patients’, families’, and health care providers’ perspectives on access and care delivery. Journal of Palliative Medicine, 23(11), 1468–1477. https://doi.org/10.1089/jpm.2019.0509
Canadian Nurses Association. (2017). Code of ethics for registered nurses. https://www.cna-aiic.ca/en/nursing/regulated-nursing-in-canada/nursing-ethics
Childers, L. (2023, August). Improving palliative care referrals across oncology. Oncology Nursing News.
Christian Medical and Dental Society of Canada v. College of Physicians and Surgeons of Ontario, 2019 ONCA 393 (CanLII). (2019, May 15). Canlii.org; CanLII. https://www.canlii.org/en/on/onca/doc/2019/2019onca393/2019onca393.html
Canadian Nurses Protective Society. (2024). Medical assistance in dying: What every nurse should know. https://cnps.ca/article/medical-assistance-in-dying-what-every-nurse-should-know/
Coelho, A., de Brito, M., Teixeira, P., Frade, P., Barros, L., & Barbosa, A. (2020). Family caregivers’ anticipatory grief: A conceptual framework for understanding its multiple challenges. Qualitative Health Research, 30(5), 693–703. https://doi.org/10.1177/1049732319873330
College of Nurses of Ontario. (2021). Guidance on nurses’ roles in medical assistance in dying. https://cno.org/Assets/CNO/Documents/Standard-and-Learning/Practice-Standards/41056-guidance-on-nurses-roles-in-maid.pdf
College of Physicians and Surgeons of Ontario. (2008). Human rights in the provision of health services. https://www.cpso.on.ca/en/physicians/policies-guidance/policies/human-rights-in-the-provision-of-health-services
Davidson, J. E., Bojorquez, G., Upvall, M., Stokes, F., Bosek, M. S. D., Turner, M., & Lee, Y. S. (2022). Nurses’ values and perspectives on medical aid in dying: A survey of nurses in the United States. Journal of Hospice and Palliative Nursing, 24(1), 5–14. https://doi.org/10.1097/ NJH.0000000000000820
Dees, M. K., Vernooij-Dassen, M. J., Dekkers, W. J., Elwyn, G., Vissers, K. C., & Van Weel, C. (2013). Perspectives of decision-making in requests for euthanasia: A qualitative research among patients, relatives and treating physicians in the Netherlands. Palliative Medicine, 27(1), 27–37. https://doi.org/10.1177/0269216312463259
Denier, Y., Gastmans, C., De Bal, N., & Dierckx De Casterlé, B. (2010). Communication in nursing care for patients requesting euthanasia: A qualitative study. Journal of Clinical Nursing, 19(23–24), 3372–3380. https://doi.org/10.1111/j.1365-2702.2010.03367.x
DeWolf, T., & Cazeau, N. (2022). Medical aid in dying: An overview of care and considerations for patients with cancer. Clinical Journal of Oncology Nursing, 26(6), 621–627. https://doi.org/10.1188/22.CJON.621-627
Frolic, A. N., Swinton, M., Murray, L., & Oliphant, A. (2020). Double-edged MAiD death family legacy: A qualitative descriptive study. BMJ Supportive and Palliative Care. Advance online publication. https://doi.org/10.1136/bmjspcare-2020-002648
Fujioka, J. K., Mirza, R. M., McDonald, P. L., & Klinger, C. A. (2018). Implementation of medical assistance in dying: A scoping review of health care providers’ perspectives. Journal of Pain and Symptom Management, 55(6), 1564–1576.e9. https://doi.org/10.1016/j.jpainsymman.2018.02.011
Goldberg, R., Nissim, R., An, E., & Hales, S. (2021). Impact of medical assistance in dying (MAiD) on family caregivers. BMJ Supportive and Palliative Care, 11, 107–114. https://doi.org/10.1136/bmjspcare-2018-001686
Hales, B. M., Bean, S., Isenberg-Grzeda, E., Ford, B., & Selby, D. (2019). Improving the medical assistance in dying (MAID) process: A qualitative study of family caregiver perspectives. Palliative and Supportive Care, 17(5), 590–595. doi:10.1017/S147895151900004X
Harrington, S. E., & Smith, T. J. (2008). The role of chemotherapy at the end of life: “When is enough, enough?” JAMA: The Journal of the American Medical Association, 299(22), 2667–2678. https://doi.org/10.1001/jama.299.22.2667
Harvey, P., & Ahmann, E. (2016). Validation: A family-centered communication skill. Nephrology Nursing Journal, 43(1), 61+. https://link-gale-com.uml.idm.oclc.org/apps/doc/A445116782/HRCA?u=univmanitoba&sid=bookmark-HRCA&xid=16a323c1
Health Canada. (2017, October 6). 2nd interim report on medical assistance in dying in Canada. https://www.canada.ca/en/health-canada/services/publications/health-system-services/medical-assistance-dying-interim-report-sep-2017.html
Health Canada. (2023). Fourth annual report on medical assistance in dying in Canada 2022. Government of Canada.
Hospice and Palliative Nurses Association. (2017). Guidelines for the role of the RN and APRN when hastened death is requested. https://advancingexpertcare.org/position -statements
Kremeike, K., Galushko, M., Frerich, G., Romotzky, V., Hamacher, S., Rodin, G., Pfaff, H., & Voltz, R. (2018). The DEsire to DIe in Palliative care: Optimization of Management (DEDIPOM) – A study protocol. BMC Palliative Care, 17(1), 30–30. https://doi.org/10.1186/s12904-018-0279-3
Liu, T., Liu, W., Leung, A., Jia, S., Lee, P., Liu, L., Mutsaers, A., Miller, S., Honarmand, K., Malik, S., Qu, M., & Ball, I. (2022). Medical assistance in dying in oncology patients: A Canadian academic hospital’s experience. Current Oncology (Toronto), 29(12), 9407–9415. https://doi.org/10.3390/curroncol29120739
Munro, C., Romanova, A., Webber, C., Kekewich, M., Richard, R., & Tanuseputro, P. (2020). Involvement of palliative care in patients requesting medical assistance in dying. Canadian Family Physician, 66(11), 833–842. https://www.cfp.ca/content/cfp/66/11/833.full.pdf
Pesut, B., Thorne, S., Schiller, C., Greig, M., Roussel, J., & Tishelman, C. (2020). Constructing good nursing practice for medical assistance in dying in Canada: An interpretive descriptive study. Global Qualitative Nursing Research, 7, Article 2333393620938686. https://doi.org/10.1177/2333393620938686
Pornrattanakavee, P., Srichan, T., Seetalarom, K., Saichaemchan, S., Oer-Areemitr, N., & Prasongsook, N. (2022). Impact of interprofessional collaborative practice in palliative care on outcomes for advanced cancer inpatients in a resource-limited setting. BMC Palliative Care, 21(1), 229–229. https://doi.org/10.1186/s12904-022-01121-0
Powell, T. L. (2023) Shaping experiences: Exploring the impact of legislation, policy and programs on family members of MAID recipients. [Unpublished doctoral dissertation, University of Victoria]. http://hdl.handle.net/1828/15801
Salamon, M. (2023, August 14). Validation: Defusing intense emotions. Harvard Health Publishing. https://www.health.harvard.edu/blog/validation-defusing-intense-emotions-202308142961.
Saskatchewan Health Authority. (2022). Provincial MAID Program: A resource for facilities and caregivers. https://www.saskhealthauthority.ca/sites/default/files/2022-10/A-Resource-for-Facilities-and-Caregivers.pdf
Schuklenk, U. (2018). Conscientious objection in medicine: Accommodation versus professionalism and the public good. British Medical Bulletin, 12(6), 47–56. http://doi.org/10.1093/bmb/Idy007
Shanawani, H. (2016). The challenges of conscientious objection in health care. Journal of Religious Health, 55, 384–393. http://doi.org/10.1007/s10943-016-0200-4
Smolej, E., Malozewski, M., McKendry, S., Diab, K., Daubert, C., Farnum, A., Orianna, S., Reel, K., & Cameron, J. I. (2023). A qualitative study exploring family caregivers’ support needs in the context of medical assistance in dying. Palliative and Supportive Care, 21(2), 254–260. https://doi.org/10.1017/S1478951522000116
Spine, K., Skwira-Brown, A., Schlifke, D., & Carr, E. (2022). Clinical oncology nurse best practices: Palliative care and end-of-life conversations. Clinical Journal of Oncology Nursing, 26(6), 612–620. https://doi.org/10.1188/22.CJON.612-620
Variath, C., Peter, E., Cranley, L., Godkin, D., & Just, D. (2020). Relational influences on experiences with assisted dying: A scoping review. Nursing Ethics, 27(7), 1501–1516. https://doi.org/10.1177/0969733020921493
Washington, K. T., Benson, J. J., Chakurian, D. E., Popejoy, L. L., Demiris, G., Rolbiecki, A. J., & Oliver, D. P. (2021). Comfort needs of cancer family caregivers in outpatient palliative care. Journal of Hospice and Palliative Nursing: JHPN: The Official Journal of the Hospice and Palliative Nurses Association, 23(3), 221–228. https://doi.org/10.1097/NJH.0000000000000744
Yan, H., Bytautas, J., Isenberg, S. R., Kaplan, A., Hashemi, N., Kornberg, M., & Hendrickson, T. (2023). Grief and bereavement of family and friends around medical assistance in dying: A scoping review. BMJ Supportive & Palliative Care, 13, 414–428. https://spcare.bmj.com/content/13/4/414
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