A Cross-Sectional Study of Palliative Care Nurse Attitudes Toward Medical Assistance in Dying
Bibliographic record
Abstract
Background: In 2015, the Supreme Court of Canada decriminalized physician assisted dying for persons suffering grievous and irremediable medical conditions. In Canada, Medical Assistance in Dying (MAiD) is not provided by professional nurses; however, nurses are involved in providing physical care, education, and support for persons who are in various stages of the process. Its integration in palliative care settings has been controversial as MAiD is philosophically at odds with a palliative care approach that seeks to neither hasten nor prolong natural death. Therefore, it has potential to create moral and ethical distress among palliative care nurses who respect adherence to the tenets of palliative care.\nObjectives: The objectives of this study were to explore the attitudes of palliative care nurses toward MAiD and to identify their professional support needs.\nMethods: We conducted a cross-sectional survey of palliative care registered nurses and registered practical nurses in Ontario, Canada. Letters that provided a link to an online survey were sent to participants by standard mail. Participants completed a novel instrument, the Nurse Attitudes Toward MAiD Scale (NATMS) that included 24 items ranked on a 5-point Likert-type scale (1= ‘strongly disagree’ to 5= ‘strongly agree’). Data analyses included univariate and bivariate statistics, and linear regression.\nResults: The final sample (N=239) included 173 registered nurses and 66 registered practical nurses who had worked in nursing for >20 years, and in palliative care for >10 years. The overall score on the NATMS was 3.42 + 0.62. Perceived expertise in the social domain of palliative care (β = 0.16; p=0.02), personal importance of religion/faith (β = -0.40; p=0.00), professional importance of religion/faith (β = -0.22; p=0.01) and nursing designation (β=-.18; p=0.03) predicted the NATMS score. Ethics training and clear policies for MAiD integration were reported as required supports in palliative care work environments.\nConclusions: This is the first study to reveal the perceived importance of religion, versus religious affiliation alone, as significant in influencing provider attitudes toward assisted dying. Organizations are encouraged to address the professional needs of palliative care nurses. To support MAiD integration, further research is needed to understand differences in attitudes between registered nurses and registered practical nurses, and how the social domain of palliative care influences nurse attitudes toward MAiD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".