Specialty Differences in Medical Aid in Dying Experiences: Results of a Survey of Physicians in Colorado

Abstract

In Colorado, medical aid in dying (MAiD) is legal, allowing a terminally ill person to request a prescription and self-administer a medication to end their life. Such requests are granted under certain circumstances, including a malignant neoplasm diagnosis, with a goal of peaceful death. This study examined differences in attitudes and actual participation in MAiD between oncologists and non-oncologists, using data from a recent survey of physicians regarding MAiD.

Introduction

Medical aid in dying (MAiD) occurs when a physician provides a patient with a prescription for a medications which result in death.¹ In Colorado, this process allows a terminally ill person to self-administer a medication to end their life and allows a physician to prescribe such a medication to such an individual under certain circumstances. This is generally a prescription, self-administered orally by a patient with a goal of peaceful death within 1-2 hours, and includes multiple agents (eg, digoxin, diazepam, morphine, amitryptiline). Most MAiD prescriptions are tied to a malignant neoplasm diagnosis. Colorado law requires one physician to primarily guide the process and write the prescription, while a consulting physician meets with a patient once to confirm eligibility. No study has examined how oncologists’ attitudes and actual participation in MAiD differs from ­non-oncologists. To fill this important knowledge gap, we analyzed data from a recent survey of physicians regarding MAiD.

Methods

The methods of this anonymous, mailed survey of 583 physicians in Colorado have been published elsewhere^2,3 (response rate 55%). Chi-squared tests compared descriptive characteristics by specialty group. The IRB approved this study.

Results

The survey population included oncologists/hematologists (18.1%), primary care (internal medicine and family practice, 52.8%), and other specialists (29.2%). The respondents represented the physician workforce in Colorado as predominantly male (60.1%), White non-Hispanic (79.3%). The respondents worked in both inpatient and outpatient (94.2% oncology; 19.9% primary care; 60.7% other specialties) and outpatient only (5.8% oncology; 78.9% primary care; 22.6% other specialties). The experience was split as 52.1% with less than 10 years of practice experience, and 47.9% with more than 10 years. Oncologists and other specialists had less experience (61.5% and 64.3% <10 years) than the primary care respondents (42.1% <10 years). Additionally, the majority had no nursing home or hospice work (82.4%).

Respondents rated how prepared they were to discuss MAiD with patients, refer for MAiD, consult on a MAiD case, and serve as a MAiD attending (Fig. 1). Related to preparation, oncologists were significantly more likely than primary care physicians and other specialists to feel “generally prepared” or “very prepared” to discuss MAiD with a patient (69.2% vs 55.3% vs 47.6%, 
P = .04), to consult on a MAiD case (48.1% vs 28% vs 27.2%, 
P = .01) or to serve as a MAiD attending (30.8% vs. 16% vs. 16.1%, P = .04). Related to experiences, oncologists were significantly more likely than primary care physicians and other specialists to have discussed MAiD with a patient (78.9% vs 52% v.40.5%, P < .001), provide MAiD referrals (48.1% vs. 23.7% vs.24.2%, P < .001), serve as a MAiD consultant (32.7% vs.7.9% vs. 10.8%, P < .001), or serve as a MAiD attending (23.2% vs. 6% vs 4.8%, 
P < 001).

Respondents also rated the strength of potential barriers to their participation in MAiD. Figure 2 shows that oncologists were significantly less likely than primary care physicians and other specialists to report their lack of knowledge of MAiD was a “moderate” or “large barrier” to participating in MAiD (21.2% vs. 49.3% vs. 56%, 
P < .001).

Discussion

We found oncologists feel more prepared to provide MAiD services and have done so at higher rates than other types of physicians. These findings have several important implications. First, given that cancer is the most common illness for people who receive a MAiD prescription in Colorado, it is reassuring that oncologists are fairly willing to provide MAiD services. This may be due to the continuity of care shift that occurs as patients face life limiting cancer and spend more time with their oncologists than other providers. This may also be because oncologists may see a higher proportion of patients who are expected to live less than 6 months due to their illness, for whom MAiD is an option.

Second, our results show that oncologists feel significantly more prepared to provide MAiD services which could result from greater attention to and education about MAiD in oncology compared to other specialties. It may also reflect the fact that oncologists provide MAiD services more frequently and thus feel more prepared. Oncology practices may also have more robust MAiD infrastructures than primary care or other specialty practices.

Third, our findings provide empirical data that patients with advanced cancer may use to inform their consideration of MAiD discussions. They may prioritize holding discussions with their oncologist more so than with their primary care provider.

Finally, these data have implications for future research. For example, it would be important to explore if MAiD ­related attitudes and experience influence patients’ choice in oncologic care or affects long-standing physician-patient treatment relationships.

Funding

This study was funded by The Greenwall Foundation Making a Difference Program.

Conflict of Interest

The authors indicated no financial relationships.

Author Contributions

Conception/design: All authors. Provision of study material or patients: J.R., E.G.C. Collection and/or assembly of data: J.R., V.K. Data analysis and interpretation: J.R., V.K., E.G.C. (All reviewed). Manuscript writing: E.R.K., J.R., E.G.C. Final approval of manuscript: All authors.

Data Availability

The data underlying this article will be shared on reasonable request to the corresponding author.

References