How is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study
Open accessAbstract
Objectives: The aims of this study are: (1) to create a flowchart process model of how medical assistance in dying (MAID) occurs in Nova Scotia (NS), Canada and (2) to detail how NS healthcare professionals are involved in each stage of MAID. The research questions are: how is the MAID process carried out and which professionals are involved at which points? and which roles and activities do professionals carry out during MAID? Design: Qualitative process model flowchart study with semistructured interviews. Setting: Primary and secondary care in NS, Canada. Participants: Thirty-two interviewees self-selected to participate (12 physicians, 3 nurse practitioners (NP), 6 nurses, 6 pharmacists and 5 healthcare administrators and advocates). Participants were included if they conduct assessments, provide MAID, fill prescriptions, insert the intravenous lines, organise care and so on. Results: The flowchart process model details five stages of how MAID occurs in NS: (1) starting the MAID process, (2) MAID assessments, (3) MAID preparation (hospital in-patient, hospital outpatient, non-hospital), (4) day of MAID and (5) post-MAID (hospital in-patient and outpatient, non-hospital, after leaving setting). Nineteen points where the process could stop or be delayed were identified. MAID differs slightly by location and multiple professionals from different organisations are involved at different points. Some physicians and NP provide MAID for free as they cannot be reimbursed or find it too difficult to be reimbursed. Conclusions: Our study adds knowledge about the MAID activities and roles of NS professionals, which are not documented in the international literature. Clinicians and pharmacists spend significant additional time to participate, raising questions about MAID’s sustainability and uncompensated costs. The process model flowchart identifies where MAID can stop or be delayed, signalling where resources, training and relationship-building may need to occur. Knowing where potential delays can occur can help clinicians, administrators and policymakers in other jurisdictions improve MAID.
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These perspectives support and are supported by prior research calling for MAiD care coordination, inter-professional approaches, and attention to applicants' and families' emotional, social and spiritual needs.
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Cites
Handbook of Qualitative Research
Crozier, G., Denzin, N., & Lincoln, Y. (1994) · British Journal of Educational Studies · doi:10.2307/3121684 · Cited by 26,636 · see citing works
Strategies for Theorizing from Process Data
Langley, A. (1999) · The Academy of Management Review · doi:10.5465/amr.1999.2553248 · Cited by 7,008 · see citing works
SAGE Handbook of Mixed Methods in Social & Behavioral Research
Tashakkori, A., & Teddlie, C. (2010) · doi:10.4135/9781506335193 · Cited by 6,215 · see citing works
Qualitative research: standards, challenges, and guidelines
Malterud, K. (2001) · The Lancet · doi:10.1016/s0140-6736(01)05627-6 · Cited by 5,014 · see citing works
Canadian Institute for Health Information.
Lalonde, A. (1994) · PubMed · Cited by 4,730 · see citing works
Explaining Development and Change in Organizations
van de Ven, A. H., & Poole, M. S. (1995) · The Academy of Management Review · doi:10.5465/amr.1995.9508080329 · Cited by 3,762 · see citing works
Goodman, L. A. (1961) · The Annals of Mathematical Statistics · doi:10.1214/aoms/1177705148 · Cited by 3,606 · see citing works
Qualitative Text Analysis: A Guide to Methods, Practice & Using Software
Kuckartz, U. (2014) · doi:10.4135/9781446288719 · Cited by 1,411 · see citing works
Validity, reliability, and generalizability in qualitative research
Leung, L. (2015) · Journal of Family Medicine and Primary Care · doi:10.4103/2249-4863.161306 · Cited by 1,404 · see citing works
Validity, trustworthiness and rigour: quality and the idea of qualitative research
Rolfe, G. (2006) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2006.03727.x · Cited by 1,181 · see citing works
Sampling: how to select participants in my research study?
Martínez-Mesa, J., González‐Chica, D. A., Duquia, R. P., Bonamigo, R. R., & Bastos, J. L. (2016) · Anais Brasileiros de Dermatologia · doi:10.1590/abd1806-4841.20165254 · Cited by 400 · see citing works
What Makes a Process Theoretical Contribution?
Cloutier, C., & Langley, A. (2020) · Organization Theory · doi:10.1177/2631787720902473 · Cited by 366 · see citing works
Getting Leopards to Change their Spots: Co-creating a New Professional Role Identity
Reay, T., Goodrick, E., Waldorff, S. B., & Casebeer, A. L. (2016) · Academy of Management Journal · doi:10.5465/amj.2014.0802 · Cited by 254 · see citing works
Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada
Li, M., Watt, S., Escaf, M., Gardam, M. A., Heesters, A. M., O’Leary, G., & Rodin, G. (2017) · New England Journal of Medicine · doi:10.1056/nejmms1700606 · Cited by 175 · see citing works
Health care process modelling: which method when?
Jun, G. T., Ward, J., Morris, Z. S., & Clarkson, P. J. (2009) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzp016 · Cited by 160 · see citing works
Medical assistance in dying (MAiD): Canadian nurses’ experiences
Beuthin, R. E., Bruce, A., & Scaia, M. (2018) · Nursing Forum · doi:10.1111/nuf.12280 · Cited by 135 · see citing works
Fujioka, J. K., Mirza, R. M., McDonald, P. L., & Klinger, C. A. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2018.02.011 · Cited by 127 · see citing works
Early experience with medical assistance in dying in Ontario, Canada: a cohort study
Downar, J., Fowler, R. A., Halko, R., Huyer, L. D., Hill, A. D., & Gibson, J. L. (2020) · Canadian Medical Association Journal · doi:10.1503/cmaj.200016 · Cited by 95 · see citing works
Medical Assistance in Dying: A Review of Canadian Nursing Regulatory Documents
Pesut, B., Thorne, S. E., Stager, M. L., Schiller, C. J., Penney, C., Hoffman, C., Greig, M., & Roussel, J. (2019) · Policy Politics & Nursing Practice · doi:10.1177/1527154419845407 · Cited by 75 · see citing works
Khoshnood, N., Hopwood, M.-C., Lokuge, B., Kurahashi, A. M., Tobin, A., Isenberg, S. R., & Husain, A. F. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2018.05.006 · Cited by 70 · see citing works
Madan, T. N. (1992) · Social Science & Medicine · doi:10.1016/0277-9536(92)90335-n · Cited by 62 · see citing works
Hales, B. M., Bean, S., Isenberg-Grzeda, E., Ford, B., & Selby, D. (2019) · Palliative and Supportive Care · doi:10.1017/s147895151900004x · Cited by 62 · see citing works
Relational influences on experiences with assisted dying: A scoping review
Variath, C., Peter, E. H., Cranley, L. A., Godkin, D., & Just, D. T. (2020) · Nursing Ethics · doi:10.1177/0969733020921493 · Cited by 54 · see citing works
Reasons for requesting medical assistance in dying.
Wiebe, E. R., Shaw, J., Green, S., et al. (2018) · PubMed · Cited by 52 · see citing works
Brooks, L. (2019) · Canadian Journal on Aging / La Revue canadienne du vieillissement · doi:10.1017/s0714980818000600 · Cited by 52 · see citing works
Provision of medical assistance in dying: a scoping review
Zworth, M., Saleh, C., Ball, I. M., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-036054 · Cited by 49 · see citing works
Oczkowski, S. J. W., Crawshaw, D., Austin, P., Versluis, D., Kalles-Chan, G., Kekewich, M., Curran, D., Miller, P. Q., Kelly, M., Wiebe, E. R., et al. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.08.018 · Cited by 45 · see citing works
Providing medical assistance in dying: Practice perspectives.
Shaw, J., Wiebe, E. R., Nuhn, A. A., Holmes, S., Kelly, M., & Just, A. L. (2018) · Europe PMC (PubMed Central) · Cited by 44 · see citing works
Nuhn, A. A., Holmes, S., Kelly, M., Just, A. L., Shaw, J., & Wiebe, E. R. (2018) · Europe PMC (PubMed Central) · Cited by 43 · see citing works
Medical assistance in dying (MAiD) in Canada: practical aspects for healthcare teams
Wiebe, E. R., Green, S., & Wiebe, K. (2020) · Annals of Palliative Medicine · doi:10.21037/apm-19-631 · Cited by 40 · see citing works
Victoria's voluntary assisted dying law: clinical implementation as the next challenge
White, B. P., Willmott, L., & Close, E. (2019) · The Medical Journal of Australia · doi:10.5694/mja2.50043 · Cited by 38 · see citing works
Medical Assistance in Dying (MAiD): A Descriptive Study From a Canadian Tertiary Care Hospital
Selby, D., Bean, S., Isenberg‐Grzeda, E., Henry, B., & Nolen, A. E. (2019) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909119859844 · Cited by 38 · see citing works
Care Considerations in a Patient- and Family-Centered Medical Assistance in Dying Program
Brown, J., Goodridge, D., Harrison, A., Kemp, J., Thorpe, L., & Weiler, R. (2022) · Journal of Palliative Care · doi:10.1177/0825859720951661 · Cited by 38 · see citing works
Medical Assistance in Dying: Alberta Approach and Policy Analysis
Silvius, J. L., Memon, A., & Arain, M. A. (2019) · Canadian Journal on Aging / La Revue canadienne du vieillissement · doi:10.1017/s0714980819000175 · Cited by 37 · see citing works
A National Survey of Canadian Psychiatrists’ Attitudes toward Medical Assistance in Death
Rousseau, S., Turner, S., Chochinov, H. M., Enns, M. W., & Sareen, J. (2017) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717711174 · Cited by 32 · see citing works
A Canadian Academic Hospital’s Initial MAID Experience: A Health-Care Systems Review
Ball, I. M., Hodge, B., Jansen, S., et al. (2018) · Journal of Palliative Care · doi:10.1177/0825859718812446 · Cited by 26 · see citing works
Ritchie, K., Gérin-Lajoie, C., & Naik, V. N. (2017) · New England Journal of Medicine · doi:10.1056/nejmc1708958 · Cited by 24 · see citing works
Medical assistance in dying: Examining Canadian pharmacy perspectives using a mixed-methods approach
Verweel, L., Rosenberg-Yunger, Z. R. S., Movahedi, T., & Malek, A. H. (2018) · Canadian Pharmacists Journal / Revue des Pharmaciens du Canada · doi:10.1177/1715163518754917 · Cited by 23 · see citing works
Processes of patient-centred care in Family Health Teams: a qualitative study
Brown, J. B., Ryan, B. L., & Thorpe, C. (2016) · CMAJ Open · doi:10.9778/cmajo.20150128 · Cited by 21 · see citing works
Physician-assisted dying: Review of issues and roles for health psychologists.
Sears, S. R., & Stanton, A. L. (2001) · Health Psychology · doi:10.1037//0278-6133.20.4.302 · Cited by 16 · see citing works
Wesemael, Y. V., Cohen, J., Bilsen, J. J. R., et al. (2012) · Health Policy · doi:10.1016/j.healthpol.2011.12.001 · Cited by 14 · see citing works
Hollander, M. J., Miller, J. A., & Kadlec, H. (2010) · Healthcare Quarterly · doi:10.12927/hcq.2013.21997 · Cited by 12 · see citing works
Wu, J., Pinilla, J. R., Watson, M. M., et al. (2018) · Current Oncology · doi:10.3747/co.25.4118 · Cited by 12 · see citing works
Wilson, D. M., Triscott, J. A. C., Cohen, J., et al. (2019) · Health & Social Care in the Community · doi:10.1111/hsc.12766 · Cited by 11 · see citing works
Physician-assisted dying: Review of issues and roles for health psychologists.
Sears, S. R., & Stanton, A. L. (2001) · Health Psychology · doi:10.1037/0278-6133.20.4.302 · Cited by 11 · see citing works
The provision of medical assistance in dying: protocol for a scoping review
Oczkowski, S. J. W., Ball, I. M., Saleh, C., et al. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017888 · Cited by 9 · see citing works
An entrustable professional activity descriptor for medical aid in dying: a mixed-methods study
Downar, J., Green, S., Radhakrishnan, A., et al. (2018) · CMAJ Open · doi:10.9778/cmajo.20180104 · Cited by 9 · see citing works
Hogg, S., Nippak, P. M. D., & Spalding, K. (2018) · Journal of Hospital Administration · doi:10.5430/jha.v7n5p41 · Cited by 7 · see citing works
Oregon lets state pay for suicides.
(1998) · PubMed · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [14]Bissett K. Audrey Parker’s message to Canadians, days before dying with medical assistance. The Canadian Press, 2019. Available: https://www.ctvnews.ca/canada/audrey-parker-s-message-to-canadians-days-before-dying-with-medical-assistance-1.4286147
- [41]Canadian Institute for Health Information. Medical assistance in dying: information needs for health systems and public reporting: discussion forum report, 2017. Available: https://www.cihi.ca/sites/default/files/document/MAID-proceedings-en.pdf
Cited by
Sorted by citations
Stergiopoulos, V., Bastidas-Bilbao, H., Gupta, M., Buchman, D. Z., Stewart, D. E., Rajji, T., Simpson, A. I. F., van Kesteren, M. R., Cappe, V., Castle, D., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05541-5 · Cited by 5 · see citing works
- Authors
- Crumley, E. T., Kelly, S., Young, J., Phinney, N., McCarthy, J., & Gubitz, G.
- Affiliations
- St. Francis Xavier University (CA)
- Treasury Board of Canada Secretariat (CA)
- Dalhousie University (CA)
- Nova Scotia Health Authority (CA)
- Neurology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Corresponding author
- Crumley, Ellen T
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2021-07
- Volume
- 11
- Issue
- 7
- Pages
- e048698
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC8314721
- OpenAlex
- W3185325402
- Cited by
- 31
- References
- 49
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 10 · 2023: 3 · 2022: 3 · 2021: 1
- FWCI
- 3.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- StFX Scholar (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Dalhousie University SSHRC Explore Grant (37823)
- Dalhousie University Research Development Fund (48365)
- Dalhousie Medical Research Foundation Bergmann-Porter Studentship (n/a)
- Rowe School of Business Research Grant (RRG2017-I002)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- medical assistance in dying, Nova Scotia, health professionals' role, physician reimbursement, nurse practitioners, pharmacists, primary and secondary care, end-of-life care, process delays
- MeSH terms
- Canada, Humans, Medical Assistance, Nova Scotia, Physicians, Software Design, Suicide, Assisted
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