Symposia
Health Psychology / Behavioral Medicine - Adult
Elizabeth Loggers, M.D., Ph.D.
University of Washington School of Medicine
Seattle, Washington
Introduction: Clinician support for Medical Aid in Dying (MAID) tends to be higher than self-reported willingness to participate in MAID as a prescribing provider, suggesting stigma may play a role. Willingness to act as a prescribing provider also varies by other factors, including sociodemographic factors, professional role and country of residence. To date, little has been published on the attitudes of advance practice providers (APPs; nurse practitioners and physician assistants) regarding MAID. This talk addresses the attitudes and willingness of APPs to participate in MAID by reviewing the published literature internationally, as well as presenting (as yet) unpublished data for APPs in Washington State. Washington State is the first American state to consider expanding MAID prescribing authority to APPs. While the proposed amendment to Washington State’s 2009 “Death with Dignity” Act did not pass, it sparked a local debate about the appropriateness of this expansion which was designed to improve access to MAID.
Results: A self-report survey was conducted in Fall 2021 among oncology APPs working at a comprehensive cancer center in Washington State, which supports MAID participation for its patients. 77 APPs participated (response rate of 46%); most were white (89.6%), females (93.5%), who had practiced on average 6-10 years. 91% of APPs agreed or strongly agreed MAID should be legal. Nearly 80% reported having at least one patient who had inquired about MAID, while less than a third endorsed feeling knowledgeable or very knowledgeable about any aspect of the MAID process. 51% of APPs endorsed being willing to participate in MAID either as a consulting or prescribing clinician (or both), while 40% were uncertain of whether they would participate. Personal uncertainty was significantly associated with lack of knowledge of and discomfort with MAID and lower rates of professional experience with patients pursuing MAID. In univariate logistic regression models, higher knowledge and comfort scores were both significantly associated with increased odds of being willing to participate versus unsure (OR 1.14 per one point increase in score; 95% CI: [1.03, 1.27]; p=0.01 and OR 1.18; 95% CI: [1.07, 1.30]; p=0.001).
Conclusion: This talk will present further results of the institutional survey as well as state-wide survey results from APPs of all disciplines and variable experience with MAID. Results will also include APP perceptions of stigma and the importance of colleague and institutional support in deciding whether or not to participate in MAID.