Factors That Influence Access to Medical Assistance in Dying Services: An Integrative Review

IF 3 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations Pub Date : 2024-10-17 DOI:10.1111/hex.70058

Jayne Hewitt, Michael Wilson, Ann Bonner, Melissa J. Bloomer

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引用次数: 0

Abstract

Background

In nearly all jurisdictions where it is permitted, Medical Assistance in Dying is situated in a healthcare system. Currently, limited evidence demonstrates how supply and demand factors influence access to Medical Assistance in Dying.

Objective

The aim of this study is to synthesise empirical research from jurisdictions where Medical Assistance in Dying is legal to identify how supply and demand factors influence access for eligible adults.

Method

An integrative review was conducted. CINAHL Complete, PubMed, ProQuest, PsycINFO and Embase databases were systematically searched for studies published between January 1998 and January 2024. Records were independently assessed against inclusion and exclusion criteria. Additional studies were identified by forward and backward citation searching. All studies were assessed for quality. Findings were analysed deductively using an established conceptual framework, and a secondary narrative synthesis was undertaken.

Results

Fifty-eight studies met the inclusion criteria. Most studies (n = 32) reported results related to the supply side, 16 reported on the demand side and 10 reported on both supply and demand dimensions of access. Studies about supply showed that health service policies may obstruct access to Medical Assistance in Dying. For healthcare professionals, the practice entails an additional workload and can create tensions with colleagues. Studies of the demand for Medical Assistance in Dying focused on supporting time-critical decisions, adequate planning and caregiver support.

Conclusion

Access to Medical Assistance in Dying requires the participation of health services and healthcare professionals but is hindered by policies that obstruct access and direct financial and indirect emotional labour costs. Innovative and inclusive models to promote high-quality, compassionate care at the end of life and access to Medical Assistance in Dying should be considered.

Patient or Public Contribution

Patients, caregivers and service users were involved in many of the studies included in this review, and their experiences and perspectives contributed to the analysis and synthesis in this review.

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影响获得临终医疗协助服务的因素：综合评论

背景在几乎所有允许使用临终医疗协助的司法管辖区，临终医疗协助都位于医疗保健系统中。目前，只有有限的证据表明供需因素如何影响临终医疗协助的使用。本研究旨在综合临终医疗协助合法的司法管辖区的实证研究，以确定供需因素如何影响符合条件的成年人获得临终医疗协助。方法进行综合综述。系统检索了 CINAHL Complete、PubMed、ProQuest、PsycINFO 和 Embase 数据库中 1998 年 1 月至 2024 年 1 月期间发表的研究。根据纳入和排除标准对记录进行独立评估。还通过正向和反向引文检索确定了其他研究。对所有研究进行了质量评估。采用既定的概念框架对研究结果进行演绎分析，并进行二次叙述性综合。结果 58 项研究符合纳入标准。大多数研究（n = 32）报告了与供应方相关的结果，16 项研究报告了需求方的结果，10 项研究同时报告了获取医疗服务的供应和需求两个方面的结果。有关供应方面的研究表明，医疗服务政策可能会阻碍人们获得临终医疗协助。对于医护专业人员来说，这种做法会带来额外的工作量，并可能造成与同事之间的紧张关系。对临终医疗协助需求的研究侧重于支持时间紧迫的决定、充分的规划和护理人员的支持。结论临终医疗协助的获取需要医疗服务和医疗专业人员的参与，但却受到阻碍获取的政策以及直接的经济和间接的情感劳动成本的阻碍。应考虑采用创新性和包容性的模式来促进高质量、富有同情心的临终关怀和临终医疗协助的使用。患者或公众的贡献患者、照护者和服务使用者参与了本综述中的许多研究，他们的经验和观点为本综述的分析和总结做出了贡献。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.