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      Medical assistance in dying in Canada: A scoping review on the concept of suffering

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          Abstract

          Objectives

          Medical Assistance in Dying (MAiD) has been legal in Canada since June 2016. A person can receive MAiD if their suffering cannot be relieved under conditions that they consider acceptable. Informed consent requires that the person requesting MAiD has received all the information needed to make their decision; that is, medical diagnosis and prognosis, available treatments including palliative care. The evaluation of unbearable suffering is known to be challenging as suffering is often psychological, existential, and social in nature. While interventions to relieve suffering exist, it is unclear how suffering is assessed and addressed in the literature on MAiD practice. No scoping review exists on the topic in Canada. The aim of this study was to understand how the concept of suffering was approached within the Canadian MAiD grey (GL) and scientific (peer‐reviewed) literature (SL), specifically: 1‐ How suffering is defined and assessed in the context of MAiD in Canada and 2‐ Which interventions in response to suffering are recommended within the process of obtaining informed consent for MAiD and throughout the process of MAiD itself.

          Methods

          A scoping review was conducted based on PRISMA‐SR guidelines. SL articles ( N = 1027) were identified from a review of 6 databases and GL documents ( N = 537) were obtained from the provinces of Quebec, Ontario and British Columbia. Documents were analyzed using NVivo with coding by two‐raters and continuous team discussions.

          Results

          A multidimensional definition of suffering, akin to the concept of total pain, is used. The assessment of suffering is based upon patients' reports. Tools to aid in the assessment are not comprehensively covered. Specific interventions to address suffering were often focused on active listening and the management of physical symptoms. No specific interventions were mentioned and there was no reference to clinical practice guidelines in the grey literature to address other components of suffering. The use of a multidisciplinary approach is suggested without specifying the nature of involvement.

          Conclusions

          Our review indicates that published guidelines of MAID assessments could include clearer structure around the assessment and management of suffering, with suggestions of tools that may help clarify types of suffering and reference to clinical practice guidelines and interventions to holistically attend to patient suffering with an attention on non‐physical symptoms. Guidelines would benefit from clearer explanations of how members of an interdisciplinary teams could be coherently coordinated.

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          Most cited references37

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          Using thematic analysis in psychology

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            PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

            Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
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              Scoping studies: towards a methodological framework

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                Author and article information

                Contributors
                Journal
                Psycho-Oncology
                Psycho-Oncology
                1057-9249
                1099-1611
                September 2023
                July 26 2023
                September 2023
                : 32
                : 9
                : 1339-1347
                Affiliations
                [1 ] McGill University Montreal Quebec Canada
                [2 ] Lady‐Davis Institute for Medical Research Montreal Quebec Canada
                [3 ] Jewish General Hospital Montreal Quebec Canada
                [4 ] Université du Quebec à Montreal Montreal Quebec Canada
                [5 ] Université Laval Quebec City Quebec Canada
                [6 ] Montreal Children's Hospital Montreal Quebec Canada
                Article
                10.1002/pon.6196
                37496186
                a432c09c-8c5f-478e-ad18-6cef039dfbe5
                © 2023

                http://onlinelibrary.wiley.com/termsAndConditions#vor

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