Table 2.
Assessor and provider agreement with key points on the survey
| Section; key point | Response; no. (%) of participants n = 64 |
Weighted average | ||||
|---|---|---|---|---|---|---|
| Strongly disagree | Disagree | Neutral | Agree | Strongly agree | ||
| “Do you agree that the sentence should be included and is an accurate description of the tasks performed by a competent assessor/provider?” | ||||||
| Part 1: Assessment for eligibility | ||||||
| Determining that the patient is clearly expressing a desire for MAiD and meets the criteria for MAiD established by law. | 0 (0) | 2 (3) | 4 (6) | 9 (14) | 49 (77) | 4.64 |
| Establishing that the patient is capable — namely, that he/she understands his/her medical options, including therapeutic options for the underlying illness as well as end-of-life options (including palliative care); he/she understands the reasonably foreseeable consequences of each of these options; and he/she can make a reasoned decision among these options. | 1 (2) | 0 (0) | 0 (0) | 9 (14) | 54 (84) | 4.80 |
| Identifying the cause(s) of the patient’s intolerable suffering and addressing any unmet palliative and social needs, if possible and appropriate, by engaging a palliative care or other specialized provider. | 0 (0) | 2 (3) | 5 (8) | 27 (42) | 30 (47) | 4.33 |
| Establishing that the decision is voluntary and not coerced. | 0 (0) | 1 (2) | 0 (0) | 14 (22) | 49 (77) | 4.73 |
| Obtaining corollary history and additional documentation as required. | 1 (2) | 0 (0) | 2 (3) | 20 (31) | 41 (64) | 4.56 |
| Documenting findings. (n = 63) | 1 (2) | 0 (0) | 0 (0) | 12 (19) | 50 (79) | 4.75 |
| Part 2: Preparation for the provision of MAiD | ||||||
| Communicating with the multidisciplinary team (including pharmacy, nursing, administration, when applicable) to arrange provision. | 0 (0) | 0 (0) | 1 (2) | 18 (28) | 45 (70) | 4.69 |
| Determining the patient’s preferred location and making preparations appropriate for that location. (n = 63) | 0 (0) | 1 (2) | 0 (0) | 16 (25) | 46 (73) | 4.70 |
| Determining the patient’s preferred route of administration (if more than 1 route is available in the assessor’s/provider’s jurisdiction) and making appropriate preparations. | 1 (2) | 1 (2) | 0 (0) | 19 (30) | 43 (67) | 4.59 |
| Responding appropriately to a rapid deterioration in the patient’s condition or episodes of delirium or decreased level of consciousness by expediting the provision. | 2 (3) | 3 (5) | 6 (9) | 19 (30) | 34 (53) | 4.25 |
| Part 3: Provision of MAiD | ||||||
| Counselling the patient and family about what to expect during MAiD provision. | 0 (0) | 0 (0) | 1 (2) | 12 (19) | 51 (80) | 4.78 |
| Confirming capacity and consent, and providing an opportunity to withdraw the request for MAiD. | 0 (0) | 0 (0) | 0 (0) | 11 (17) | 53 (83) | 4.83 |
| Administering medication while ensuring a caring and supportive environment. (n = 63) | 0 (0) | 0 (0) | 1 (2) | 12 (19) | 50 (79) | 4.78 |
| Attending to postdeath tasks including documentation of the provision, discussing next steps with family/caregivers, contacting the coroner when necessary and debriefing with team members. Assuring appropriate paperwork and reporting to relevant oversight authorities. | 0 (0) | 0 (0) | 2 (3) | 12 (19) | 50 (78) | 4.75 |
| “Do you agree that the sentence should be included and is an accurate description of the knowledge, skills or attitudes required by a competent assessor/provider?” | ||||||
| Knowledge: The learner should be aware of … | ||||||
| The eligibility criteria established by law and reasonable interpretations of these criteria. | 0 (0) | 0 (0) | 0 (0) | 10 (16) | 54 (84) | 4.84 |
| Areas of controversy in interpreting these criteria and the basis of the controversies. | 0 (0) | 0 (0) | 2 (3) | 24 (38) | 38 (59) | 4.56 |
| Regional/institutional requirements such as standard protocols, reporting requirements, institutional procedures and referral mechanisms. | 0 (0) | 0 (0) | 0 (0) | 18 (28) | 46 (72) | 4.72 |
| The range of medications and equipment used during MAiD. | 0 (0) | 0 (0) | 1 (2) | 18 (28) | 45 (70) | 4.69 |
| Considerations that arise when providing MAiD in the home v. in an institution. | 0 (0) | 0 (0) | 2 (3) | 24 (38) | 38 (59) | 4.56 |
| Common events that occur and signs that patient may display during the provision of MAiD. | 0 (0) | 0 (0) | 2 (3) | 21 (33) | 41 (64) | 4.61 |
| Regulations regarding organ and tissue donation. | 0 (0) | 1 (2) | 6 (9) | 36 (56) | 21 (33) | 4.20 |
| Skills: The learner should be able to … | ||||||
| Understand and assess the patient’s understanding of treatment alternatives relevant to the patient’s condition, in keeping with the expertise of the assessor. | 0 (0) | 0 (0) | 4 (6) | 25 (39) | 35 (55) | 4.48 |
| Assess and facilitate the patient’s understanding of information and ability to reason between options, particularly in patients with neurologic disease, mental illness or cognitive impairment. | 0 (0) | 0 (0) | 1 (2) | 29 (45) | 34 (53) | 4.52 |
| Recognize when additional medical information or assessments are required from other sources. 0 (0) 0 (0) 0 (0) 19 (30) 45 (70) 4.70 Prognosticate when appropriate and appreciate how prognosis might affect the eligibility or timing of MAiD. | 1 (2) | 2 (3) | 2 (3) | 30 (47) | 29 (45) | 4.31 |
| Document and communicate findings accurately. | 0 (0) | 0 (0) | 0 (0) | 18 (28) | 46 (72) | 4.72 |
| Develop a therapeutic relationship with new patients/family members in a short time frame. | 0 (0) | 0 (0) | 0 (0) | 20 (31) | 44 (69) | 4.69 |
| Assess and manage the range of emotions that can arise from the family and health care team either in respect to MAiD in general or to a particular MAiD provision. | 0 (0) | 1 (2) | 3 (5) | 20 (31) | 40 (62) | 4.55 |
| Manage enteral or intravenous access, and anticipate and troubleshoot problems that may arise during the provision of MAiD. | 1 (2) | 6 (9) | 6 (9) | 16 (25) | 35 (55) | 4.22 |
| Support family through acute grief around the time of MAiD provision. | 0 (0) | 1 (2) | 6 (9) | 18 (28) | 39 (61) | 4.48 |
| Attitudes: The learner should … | ||||||
| Demonstrate a nonjudgmental approach to patients’/families’ responses to MAiD (either positive or negative). (n = 63) | 0 (0) | 0 (0) | 0 (0) | 17 (27) | 46 (73) | 4.73 |
| Not allow personal views on MAiD to influence an eligibility assessment or a patient’s decision to proceed with MAiD or not. (n = 63) | 1 (2) | 0 (0) | 1 (2) | 16 (25) | 45 (71) | 4.65 |
| Advocate for access to MAiD when an eligible patient has requested MAiD. (n = 63) | 0 (0) | 0 (0) | 2 (3) | 21 (33) | 40 (63) | 4.60 |
| Show humility by acknowledging limitations of personal knowledge and consult experts regarding medical, legal or ethical issues outside the learner’s training and experience. (n = 63) | 0 (0) | 0 (0) | 2 (3) | 15 (24) | 46 (73) | 4.70 |
| Adapt his/her approach (by providing extra documentation or consultation) when medicolegal consequences seem more likely. (n = 63) | 0 (0) | 3 (5) | 4 (6) | 18 (29) | 38 (60) | 4.44 |
| Demonstrate a commitment to self-care and emotional support for other members of the allied health team who may be struggling with MAiD. (n = 63) | 0 (0) | 2 (3) | 1 (2) | 20 (32) | 40 (63) | 4.56 |
| Demonstrate a commitment to maintain the competence of self and others by participating in a community of practice to share experience and learn from the experience of others as the practice of MAiD and eligibility and reporting requirements evolve. (n = 63) | 0 (0) | 3 (5) | 3 (5) | 20 (32) | 37 (59) | 4.44 |
| “Do you agree that the sentence should be included and is an accurate description of the teaching approaches and entrustment decisions that should be used to determine competence?” | ||||||
| The following teaching approaches can be used | ||||||
| Didactic sessions/lectures. (n = 62) | 0 (0) | 0 (0) | 2 (3) | 39 (63) | 21 (34) | 4.31 |
| Witnessed assessments and provisions, including remote witnessing via telemedicine. (n = 61) | 0 (0) | 0 (0) | 1 (2) | 21 (34) | 39 (64) | 4.62 |
| Optional: simulated encounters with standardized patients. (n = 62) | 0 (0) | 1 (2) | 9 (14) | 34 (55) | 18 (29) | 4.11 |
| Optional: procedural simulation for vascular access. (n = 62) | 0 (0) | 2 (3) | 7 (11) | 34 (55) | 19 (31) | 4.13 |
| The following sources of information can be used to evaluate progress | ||||||
| Direct observation. (n = 62) | 0 (0) | 0 (0) | 2 (3) | 23 (37) | 37 (60) | 4.56 |
| Reviewing documentation of assessments (n = 62) | 0 (0) | 0 (0) | 0 (0) | 24 (39) | 38 (61) | 4.61 |
| Multisource feedback. (n = 62) | 0 (0) | 3 (5) | 1 (2) | 26 (42) | 32 (52) | 4.40 |
| Formal entrustment decisions (i.e., that the learner can be trusted to perform an assessment and provision of MAiD without supervision) can be made on the following bases | ||||||
| Entrustment for assessment requires more observation with varying complexity than entrustment for provision. (n = 61) | 0 (0) | 8 (13) | 6 (10) | 32 (52) | 15 (25) | 3.89 |
| Entrustment should occur after observation (in person or remotely) of 3 assessments plus provisions where the observer felt the learner demonstrated appropriate competence for unsupervised practice. Ideally, 1 of these assessments should involve a patient whose condition is highly complex. (n = 61) | 1 (2) | 12 (20) | 13 (21) | 23 (38) | 12 (20) | 3.54 |
| Most assessments are straightforward, and even several of these might not prepare the learner for challenging cases. Experience with different types of scenarios (e.g., neurologic illness, mental illness and other conditions that may affect capacity) would be ideal. For entrustment, the learner should demonstrate the ability to distinguish between straightforward and complex cases, and a willingness to ask for help with complex cases. (n = 61) | 0 (0) | 3 (5) | 5 (8) | 23 (38) | 30 (49) | 4.31 |
Note: MAiD = medical aid in dying.