Kelli I. Stajduhar

Aim: To explore the experiences of family members when a relative or close person receives medical assistance in dying. Design: Guided by Interpretive Description methodology, this qualitative study was conducted across two settings. Participants included bereaved family members of individuals who received clinician‐assisted medical assistance in dying when natural death was reasonably foreseeable and key informants connected to medical assistance in dying, palliative care and end‐of‐life organizations. Methods: Data were collected between June 2020 and February 2021 through demographic surveys, in‐depth interviews, documents and artifacts, field notes and analytic memos. Data collection and analysis occurred concurrently and iteratively, supporting the development of practice‐relevant interpretations of family members' experiences. Results: Forty‐six participants, including 31 bereaved family members and 15 key informants, participated. Three interpretive themes characterized family members' experiences: (a) ‘They want medical assistance in dying, now what?’, (b) ‘Prepared but maybe not ready’ and (c) ‘An evolving understanding about this type of death’. Family members described navigating healthcare processes, assuming practical and emotional responsibilities, and negotiating their own beliefs while supporting the individual's decision. They also described meaningful opportunities for connection and farewell alongside uncertainty, moral strain and emotional upheaval. Supporting a relative's decision to pursue medical assistance in dying did not necessarily correspond to emotional preparedness for the death or subsequent bereavement. Conclusion: Medical assistance in dying is experienced not only as an individual decision but also as a relational process with emotional, practical and moral implications for family members. A family‐in‐focus approach may complement person‐centred care by increasing the visibility of family members throughout the MAiD trajectory. Proactive communication, recognition of emotional complexity, and access to psychosocial and bereavement support may better address the needs of family members while maintaining the autonomy of the individual accessing an assisted death. Patient or Public Contribution: No Patient or Public Contribution.

Cancer is the leading cause of death for Canadians. Research by Canadian scholars has highlighted that people who experience multiple and intersecting socio-economic barriers are more likely to receive a diagnosis only after cancer has become advanced. For people who experience incarceration, structural barriers to cancer treatment and care are further exacerbated. Yet, few studies in Canada have focused specifically on the provision of cancer care in provincial correctional settings. This study explored how nurses understand and navigate the delivery of cancer care to people who are incarcerated in British Columbia. Guided by Interpretive Description (ID) and informed by actor-network theory (ANT), the research aimed to generate practice-relevant insights by examining nurses’ perspectives, experiences, and the systemic factors shaping their clinical realities. Findings from this study illustrate nurses’ views that the prison's focus on security shapes how, when, and whether cancer care is delivered. Drawing on interviews with nurses, the analysis produced the following insights: 1) institutional priorities often complicated the delivery of cancer care; 2) nurses perceived systemic stigma and institutional mistrust toward patients who are incarcerated; and 3) lack of confidentiality during healthcare encounters hindered patient-centred cancer care. Despite this, nurses frequently found ways to navigate the professional tensions arising from dual responsibilities to patient care and incarceration. These insights show how cancer care is often contingent on nurses’ ability to navigate systemic constraints and relational barriers, underscoring the need for integrated, trauma-informed, and equity-oriented approaches that support continuity of care across correctional and healthcare systems.

Background: Cultural silence around death and dying due to fear, anxiety, norms, taboos, and beliefs has led to social initiatives that are more ‘death-positive’. This silence has had a disproportionate impact on young adults. ‘Death literacy’ has emerged to support greater community awareness and understanding of end-of-life care options through education and dialogue. Arts-based approaches may be particularly relevant for young adults, yet research remains limited. Objectives: This knowledge translation project explored arts-based approaches for translating palliative care narrative data into creative forms, examining the feasibility of converting research narratives into accessible art forms that could facilitate engagement with death-related topics. Design: This project employed an arts-based knowledge translation approach, co-designing a course for undergraduate artists with researchers, artists and faculty to translate palliative care narratives. Methods: The course utilized anonymized text from ethnographic research (K.S. PhD data) examining families and healthcare providers navigating paediatric transplant and palliative care, drawing from 145 journal entries by 18 healthcare providers who documented experiences of empathy, illness, suffering and death. Four undergraduate artists created diverse art forms including collages, sketches, digital drawings, storyboards and journey maps. Results: Over 25 artistic works illustrating death and dying experiences were created. The collaborative translation process revealed that undergraduate artists could effectively interpret and visualize complex palliative care narratives through diverse artistic approaches. Course evaluations and informal feedback indicated that artists found the experience meaningful and challenging, and expressed interest in further exploration of death-related topics. Conclusion: The translation process produced accessible visual interpretations of complex illness narratives and, based on course feedback, appeared to facilitate openness to death-related discussions. These findings suggest arts-based translation approaches warrant further exploration as potential tools for enhancing death literacy, with future research needed to systematically evaluate their impact on young adults’ comfort and competence with end-of-life topics.

While most people express a preference to be cared for and die at home, not all people have access to a safe or stable home. Government policies often posi

Background: Developing robust care systems to support the evolving landscape of Medical Assistance in Dying (MAID) in Canada has proven difficult. The complexity of applicants applying under Track 2, in which a reasonably foreseeable natural death is not required for eligibility, has challenged the capacities of systems that were initially developed to care for Track 1 applicants. Objective: To identify structures and practices described by healthcare providers involved in Track 2 care as key to developing a robust system of high quality and safe care for persons applying under Track 2 MAID in Canada. Design: A qualitative study informed by the principles of Interpretive Description, a pragmatic research approach developed for health disciplines. Methods: Fifty-five healthcare providers, MAID program administrators, and key informants participated in semi-structured interviews. Interviews were conducted over Zoom™, audio-recorded, transcribed, and analysed using strategies outlined in Interpretive Description. Results: The work of Track 2 care was described as complex, emotionally-laden, risky, and in some regions, inadequately remunerated. MAID coordination centres were effective for Track 2 care when they were team-based; had a structured intake that supported assessors and managed the expectations of applicants; and provided education and navigation support for applicants and family. The coordination centre role was particularly critical when applicants had no primary care provider. The availability of prospective interdisciplinary case consultation was considered essential for optimizing care in the context of Track 2 applicants. Conclusion: The assessment for, and provision of, MAID is unique in healthcare. It is the only federally legislated healthcare act, and it is irreversible. It is also morally contentious, particularly in the case with Track 2 where applicants’ years of life lost may be significant. The safe and effective implementation of Track 2 requires a robust systems approach that to-date is available in only some regions of Canada.

A positive healthcare environment and effective nurse recruitment are widely recognized as interconnected factors that improve outcomes for patients, families, and staff. Despite this, frontline nurses and their managers often have conflicting views on workplace issues. Although some hospitals have implemented “speak‐up” initiatives, nurses in acute care settings still feel silenced, as interventions designed to improve workplace culture have had limited long‐term impact. This underscores the need for a deeper understanding of how nurses are silenced. This qualitative, ethnographic study aimed to improve our understanding of how nurses are silenced in the acute care workplace. Through semi‐structured interviews with registered nurses ( n = 14) and administrators ( n = 9), observational field notes (20 h), and documents ( n = 8), we found that although nurses used various channels to voice concerns about patient safety, patient‐centered care, and workplace health to their managers, they still felt ignored and unsupported, leading to feelings of vulnerability, anger, and abandonment. Administrators understood staff frustrations but felt powerless, seeing themselves as conduits for top‐down directives rather than active participants in organizational initiatives. These findings offer crucial insights for clinicians, researchers, educators, and administrators aiming to create a more inclusive culture that prioritizes collaboration and high‐quality care.

Identifying and addressing inequities in palliative care is an area of growing interest and importance. In this critical essay, we aim to challenge embedded assumptions about ‘family’ caregiving in white, Western systems (e.g. that of the nuclear family as carers) and focus on how the social determinants of health (SDOH; e.g. income and social protection, housing, education, food security) affect access to, and quality of, care at the end of life. More specifically, our analysis pays attention to what shapes the SDOH themselves including how racism, classism, heterosexism, and ableism become embedded and sustained in health and social institutions including palliative care. We begin by providing a brief discussion of the study of ‘family’ including the nuclear family standard and fictive kinship as an ‘alternative’ family form. Next, we focus on fictive kinship in two diverse populations – (1) street-involved youth who form street families; and (2) older adults who access care beyond nuclear families – that challenge embedded assumptions and help set a foundation for thinking about family and caregiving in contexts of inequities. Drawing on short vignettes, we then focus on emerging issues in palliative care and ‘family’ caregiving in contexts of homelessness and housing vulnerability. These issues include how caregivers in contexts of homelessness are, themselves, facing structural vulnerability; bio-legal family estrangement, reunification, and privileging; and how community service workers are filling both formal and informal caregiving roles. We conclude by delineating ongoing questions, research and practice gaps, and suggestions for future research in this area.

We aimed to improve the quality of life (QOL) of homecare patients (≥ 55 years of age) who had chronic life-limiting conditions and that of their family caregivers by making QOL assessment data available via a digital QOL and practice support system (QPSS). We hypothesized that access to QPSS data in home health care would result in improved QOL for patients or their family caregivers. We further sought to understand how to integrate the use of QOL information into home health care. Our mixed-methods study, including a pragmatic randomized controlled trial (PrCT; registered at ClinicalTrials.gov #NCT02940951), was conducted with nine home healthcare teams in Canadian urban areas. The qualitative research included focus groups and interviews with home healthcare teams (N = 118) to determine how to integrate the QPSS into their practice. Participating homecare patients were assigned to an intervention group (N = 166), where home healthcare teams had access to patients’ and their family caregivers’ QOL data via the QPSS, or a usual care group (N = 165). Where possible, one family caregiver per patient was recruited (intervention N = 62; usual care N = 51). Primary outcomes, measured every two months for one year, were patients’ and family caregivers’ QOL trajectories. Longitudinal structural equation models were used to compare the trajectories. The home healthcare teams preferred to have QOL scores presented as tables and graphs, with family caregivers’ data linked to each patient. Despite the enthusiasm expressed by the home healthcare teams, and efforts to satisfy their preferences, they infrequently accessed the QOL information. While we observed substantial individual-level variability in patients’ and family caregivers’ QOL trajectories, the average trajectories for the PrCT groups were similar. Making QOL assessment data available via a digital platform may not be sufficient to achieve measurable improvements for patients and family caregivers.