Interdisciplinary US Hospice Clinician Presence Throughout the Medical Aid in Dying Procedure

Abstract

Context: Although hospice policies vary in where they permit staff to be physically located during key stages of the medical aid in dying (MAID) procedure, data needed to inform best practices concerning if and how clinicians themselves are present are lacking.

Objectives: To (1) assess the sample proportion of clinician presence during each individual stage of the MAID procedure and (2) typologize the distinct trajectories of clinician presence across stages of the MAID procedure.

Methods: We used secondary cross-sectional survey data from a convenience sample of interdisciplinary US hospice clinicians indicating permissive state and organizational MAID participation policies. Participants reported whether they had ever been present during medication self-administration, after medication self-administration, and after death by indicating if they had been in the same room, in the same residence but not the same room, or never present. We assessed presence and typologized trajectories via frequency and percentage.

Results: The sample comprised 106 hospice physicians, nurses, social workers, and chaplains. The sample majority reported never having been present during any stage. Across stages, the sample demonstrated 13 distinct trajectories of clinician presence. The most common trajectories illustrated uniformity in physical location across stages. The remaining trajectories reflected transitions in physical locations across stages. Transition subgroups depicted increasing proximity to bedside, increasing distance from bedside, and a combination of both.

Conclusions: High variability in hospice clinician presence throughout the MAID procedure may differentially affect patient care. Future best-practices research should explore stakeholder experiences of trajectories and stratify trajectories by professional discipline.

Keywords: Medicare hospice benefit; clinicians; end-of-life care; hospice; medical aid in dying; presence.