Characterizing Interdisciplinary U.S. Hospice Clinician Presence During Patient Self-Administration of Medical Aid in Dying Medication

Abstract

Background: Despite emerging as a clinical and scholarly focus in medical aid in dying (MAID)-related care, limited data exist to characterize hospice clinician presence while patients self-administer the medication to hasten their death. Objectives: To explore (1) the proportion and (2) correlates of interdisciplinary hospice clinician presence during patient self-administration of MAID medication. Design: Exploratory secondary analysis of cross-sectional survey data. Setting/Subjects: Convenience sample of interdisciplinary U.S. hospice clinicians reporting permissive state and organizational MAID policy. Measurements: We assessed the proportion of the sample ever having been present during patient self-administration of MAID medication via frequency and percentage. We examined personal, professional, organizational, and MAID-specific characteristics as correlates via multiple logistic regression analysis adjusted for small sample bias. Results: Our sample included 100 hospice physicians, nurses, social workers, and chaplains. Descriptive results revealed that just over one-third of the sample had ever been present during patient self-administration of MAID medication. Regression results indicated that being a chaplain and working for a hospice with a policy permitting full MAID participation were each significantly associated with greater odds of ever having been present. Conversely, never having provided end-of-life care beyond information provision related to a hospice patient's use of MAID was significantly associated with lower odds of ever having been present. Conclusions: Hospice clinician presence during patient self-administration of MAID medication appears relatively common and related to select professional, organizational, and MAID-specific characteristics. Improved annual state reporting practices and expanded replication efforts are warranted.

Keywords: clinicians; end-of-life care; hospice; medical aid in dying; medication; self-administration.