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Caring for a parent during emerging adulthood may be a disruptive and non-normative experience. Despite the growing prevalence of emerging adult (EA) caregivers, there remains limited research. We explored the experiences of EAs caring for parents living with advanced disease. Interviews were conducted with 12 EA daughters and analyzed using constructivist grounded theory. The core category was identified as negotiating accelerated adulthood, a dynamic interplay between feeling more of an adult than before and the paradoxical feeling of I'm not where I should be. Prior to the core category, participants' caregiving role is assumed. Availability of support influenced participants' process of negotiating accelerated adulthood. Findings highlight the uniqueness and developmental impact of this experience. Results suggest an interplay of different factors with how the role is assumed, appraised, and experienced by EA daughters. Greater awareness of these experiences may inform the development of tailored interventions and strategies for EA caregivers. [ABSTRACT FROM AUTHOR]

Background: Legalization of assisted dying is progressively expanding worldwide. In Canada, the Medical Assistance in Dying Act became law in 2016. As assisted dying regulations evolve worldwide, comprehending its subjective impact and broader consequences, especially on family members, becomes pivotal for shaping practice, policy, and training. Aim: The goal of this study is to understand the experience of family caregivers on the assisted dying procedure day. Design: Qualitative, thematic analysis, research using semi-structured interviews. Setting/participants: Family caregivers of patients who received assisted dying in two hospitals in Canada were recruited. Interviews were conducted at least 6 months after patient death. Conceptual saturation was achieved after analyzing 18 interviews. Results: While caregivers expressed gratitude for the availability of Medical Assistance in Dying, they also described the procedure day as potentially jarring and unsettling. We identified five aspects that shaped their experience: attuned support from the clinical team; preparation for clinical details; congruence between the setting and the importance of the event; active participation and ceremony; and pacing and timing of the procedure. Together, these aspects impacted the level of uneasiness felt by caregivers on the procedure day. Conclusions: This study emphasized the importance of a family-centered approach to delivering Medical Assistance in Dying. It underscored recognizing the needs of family caregivers during the procedure day and offering strategies to ease their experience. Healthcare providers in jurisdictions where assisted dying is legal or deliberated should consider the applicability of these findings to their unique context. [ABSTRACT FROM AUTHOR]

Background: Death anxiety is important but understudied in palliative care. New self-report measurements have been developed, but their interpretation and clinical utility may not be evident. Aim: To inform our understanding of death anxiety in patients with advanced cancer by exploring the relationship between this self-reported symptom and its clinical presentation. Design: Participants were part of a psychotherapy trial in advanced cancer. First therapy session transcripts were analyzed using interpretive description in patients reporting low, moderate, and high death anxiety on the Death and Dying Distress Scale (DADDS). Setting/participants: A total of 16 participants (10 women and 6 men) with advanced or metastatic cancer were sampled from the Princess Margaret Cancer Centre, Toronto, Canada. Six participants reported low death anxiety scores (Death and Dying Distress Scale: 0–19), five moderate (Death and Dying Distress Scale: 20–50), and five high (Death and Dying Distress Scale: 51–75). Results: The low death anxiety group exhibited psychological readiness for death, or contrastingly, non-reflectiveness about death. The moderate group recognized the imminence of mortality, which impacted treatment decisions and future plans. Prior experience with death was discussed as raising the salience of mortality. The high group felt dominated by powerful emotions and could not make sense of their situation. Their distress was exacerbated by substantial relational concerns. Conclusion: Self-reported death anxiety is affected by the awareness and ability to reflect on mortality. Death and Dying Distress Scale scores may facilitate exploration of this symptom as part of a clinical assessment and may serve to guide treatment approaches. Greater attention to death anxiety is consistent with and recommended by contemporary approaches to palliative care. [ABSTRACT FROM AUTHOR]

Introduction: Medical assistance in dying (MAiD) was legalized in Canada in 2016 for individuals with a grievous and irremediable medical condition. Upon legalization, MAiD was implemented at the provincial, territorial, and healthcare institution levels and varied across contexts. Substantial overlap exists in individuals requesting MAiD and those who are eligible and seeking palliative care (PC) services, yet policies and recommended practices to ensure optimal delivery and coordination of these services are not well-developed. Multiple models of delivery and coordination of MAiD and PC are possible, but it is unclear which model is most feasible or acceptable across Canadian health settings. Aims Objectives Theory or Methods: The aim of this qualitative study is to understand the perspectives of key MAiD and PC stakeholders across Canada regarding these services and the optimal relationship between them. Key stakeholders were purposively sampled to seek representation from diverse regions and those with leadership expertise and experience with MAiD and/or PC. Virtual semi-structured interviews were conducted with 22 stakeholders between April and June 2021. Interview transcripts were coded independently by two researchers and reconciled to identify key themes using conventional content analysis. Highlights or Results or Key Findings: Preliminary results indicated a range of participant perspectives regarding the need for integration of MAiD and PC services. Key stakeholders emphasized the centrality of patient-centered care and patient autonomy to both services. Elements perceived to improve the relationship between MAiD and PC across settings included the use of multidisciplinary teams, clear system-wide governance and leadership, enhanced training, a collegial culture of respect, and shared values and vision focused on patient-centred care. Challenges to coordinating MAiD and PC included the "competition" for mutual resources and differential access of PC and MAiD services. Conclusions: This qualitative study examined the attitudes and perspectives of key stakeholders regarding the optimal relationship between MAiD and PC services. Irrespective of the level of service integration, an emphasis on the need for education and relationship-building was highlighted for improved coordination of services. Implications for applicability/transferability sustainability and limitations: This is the first national study of the perspectives of key stakeholders of government, health system leaders, and academia regarding the delivery and integration of MAiD and PC services in Canada. Our findings will improve MAiD policy in Canada and inform MAiD policy in other jurisdictions. [ABSTRACT FROM AUTHOR]

Introduction: Canadians have had legal access to medical assistance in dying (MAiD) since 2016. However, despite substantial overlap in populations who request MAiD and who require palliative care (PC) services, policies and recommended practices regarding the optimal relationship between MAiD and PC services are not well developed. Multiple models are possible, including autonomous delivery of these services and formal or informal coordination, collaboration or integration. However, it is not clear which of these approaches are most appropriate, feasible or acceptable in different Canadian health settings in the context of the COVID-19 pandemic and in the post-pandemic period. The aim of this qualitative study is to understand the attitudes and opinions of key stakeholders from the government, health system, patient groups and academia in Canada regarding the optimal relationship between MAiD and PC services., Methods and Analysis: A qualitative, purposeful sampling approach will elicit stakeholder feedback of 25-30 participants using semistructured interviews. Stakeholders with expertise and engagement in MAiD or PC who hold leadership positions in their respective organisations across Canada will be invited to provide their perspectives on the relationship between MAiD and PC; capacity-building needs; policy development opportunities; and the impact of the COVID-19 pandemic on the relationship between MAiD and PC services. Transcripts will be analysed using content analysis. A framework for integrated health services will be used to assess the impact of integrating services on multiple levels., Ethics and Dissemination: This study has received ethical approval from the University Health Network Research Ethics Board (No 19-5518; Toronto, Canada). All participants will be required to provide informed electronic consent before a qualitative interview is scheduled, and to provide verbal consent prior to the start of the qualitative interview. Findings from this study could inform healthcare policy, the delivery of MAiD and PC, and enhance the understanding of the multilevel factors relevant for the delivery of these services. Findings will be disseminated in conferences and peer-reviewed publications., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)