APPs Support Medical Aid in Dying, But Only Half Willing to Prescribe, Consult

A new study shows that advanced practice providers (APPs) may need some additional training if medical aid in dying (MAID) prescribing were added to their scope of practice.

“On April 8, 2021, New Mexico Governor Michelle Lujan Grisham signed the Elizabeth Whitefield End-of-Life Options Act, making it the 10th US state and 11th US jurisdiction to permit MAID,” study researchers wrote in JAMA Network Open. “This law is the first in the US to allow physician assistants (PAs) and nurses licensed in advanced practice to prescribe and consult on MAID cases.”

This study was designed to assess APP knowledge of, willingness to, and comfort with acting as a prescribing or consulting clinician for MAID, which is often called death with dignity (DWD) in Washington State.

The study was a self-report survey given to APPs working at a comprehensive cancer center in Washington State in Fall 2021. Of 167 eligible APPs, 46.1% responded to the survey. The majority of respondents were White (88.3%) and women (93.5%). More than one-third identified medical oncology as their field of practice.

Almost 80% of respondents reported having had at least 1 patient who inquired about MAID. Depending on the question, less than one-third of respondents said they felt knowledgeable or very knowledgeable about any aspect of the MAID process.

Just over one-half of respondents (50.6%) said they would be willing to participate in MAID either as a consulting or prescribing clinician, but 40.3% were uncertain of whether they would participate.

“Our results suggest that although there may be a pool of APPs willing to participate in MAID, there is also a need for additional education and training about MAID,” the researchers wrote. “This need likely exists even among APPs with extensive experience with patients with terminal illness.”

The researchers found that willingness to participate in MAID was associated with having had more patients pursue MAID. Higher knowledge scores and higher comfort scores were significantly associated with increased odds of being willing to participate in MAID compared with being unsure.

Those APPs who were willing or unsure often rated their professional experience (61.4%), individual values (54.3%), and educational experience (44.3%) as being either very influential or extremely influential in their views regarding DWD.

More than 90% of respondents agreed or strongly agreed that MAID should be legal, but these views varied by willingness to participate.

“This study also raises questions about the best way to support APPs who may be considering participation in MAID but question their role or want physician support,” the researchers wrote. “This issue may be particularly salient in rural areas, where the goal of such legislation is to improve patient access, but may leave APPs with little clinician support.”

Reference

Assessment of oncology advanced practice professional willingness to participate in medical aid in dying.