Oncologists and medical assistance in dying: where do we stand? Results of a national survey of Canadian oncologists

  • G. Chandhoke R.S. McLaughlin Durham Regional Cancer Centre, Juravinski Cancer Centre
  • Gregory Pond R.S. McLaughlin Durham Regional Cancer Centre
  • O. Levine R.S. McLaughlin Durham Regional Cancer Centre
  • S. Oczkowski Hamilton Health Sciences

Abstract

Background In June 2016, when the Parliament of Canada passed Bill C-14, the country joined the small number of jurisdictions that have legalized medical assistance in dying (maid). Since legalization, nearly 7000 Canadians have received maid, most of whom (65%) had an underlying diagnosis of cancer. Although Bill C-14 specifies the need for government oversight and monitoring of maid, the government-collected data to date have tracked patient charac­teristics, rather than clinician encounters and beliefs. We aimed to understand the views of Canadian oncologists 2 years after the legalization of maid.

Methods We developed and administered an online survey to medical and radiation oncologists to understand their exposure to maid, self-perceived knowledge, willingness to participate, and perception of the role of oncologists in introducing maid as an end-of-life care option. We used complete sampling through the Canadian Association of Medical Oncologists and the Canadian Association of Radiation Oncology membership e-mail lists. The survey was sent to 691 physicians: 366 radiation oncologists and 325 medical oncologists. Data were collected during March–June 2018. Results are presented using descriptive statistics and univariate or multivariate analysis.

Results The survey attracted 224 responses (response rate: 32.4%). Of the responding oncologists, 70% have been approached by patients requesting maid. Oncologists were of mixed confidence in their knowledge of the eligibility criteria. Oncologists were most willing to engage in maid with an assessment for eligibility, and yet most refer to specialized teams for assessments. In terms of introducing maid as an end-of-life option, slight more than half the responding physicians (52.8%) would initiate a conversation about maid with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress.

Conclusions In this first national survey of Canadian oncologists about maid, we found that most respondents encounter patient requests for maid, are confident in their knowledge about eligibility, and are willing to act as assessors of eligibility. Many oncologists believe that, under some circumstances, it is appropriate to present maid as a therapeutic option at end of life. That finding warrants further deliberation by national or regional bodies for the development of consensus guidelines to ensure equitable access to maid for patients who wish to pursue it.

 

Author Biographies

G. Chandhoke, R.S. McLaughlin Durham Regional Cancer Centre, Juravinski Cancer Centre

Department of Oncology, Department of Oncology

Gregory Pond, R.S. McLaughlin Durham Regional Cancer Centre

Department of Oncology

O. Levine, R.S. McLaughlin Durham Regional Cancer Centre

Department of Oncology

S. Oczkowski, Hamilton Health Sciences

Department of Medicine, Division of Critical Care

Published
2020-07-07
How to Cite
Chandhoke, G., Pond, G., Levine, O., & Oczkowski, S. (2020). Oncologists and medical assistance in dying: where do we stand? Results of a national survey of Canadian oncologists. Current Oncology, 27(5). https://doi.org/10.3747/co.27.6295
Section
Palliative Care