An analysis of Oncology nurses' statements regarding the association of pain and suffering with requests for assistance in dying

Fear of prolonged pain and suffering is among the reasons most frequently cited as justifying requests for Physician Assisted Dying (PAD). Unfortunately, pain is significantly undertreated and many suffer needlessly (Marks and Sachar, 1973; Melzack, 1990), leading some to consider such desperate choices as PAD. The purpose of this exploratory study was to analyze the statements of oncology nurses in response to a survey about PAD to determine the context within which judgements are made and from which interventions are derived. The study was designed to address: (1) the concerns identified in responses to a vignette in which "profound suffering" is a prominent feature, (2) the concerns identified in response to a question about the degree to which physical pain can be managed, and (3) concerns about the degree to which pain is actually relieved. The technique of content analysis was used to study the written comments supplied by the respondents who were invited to elaborate on their answers to the vignette and pain questions. The sample was derived from a survey sent to 2,000 randomly selected oncology nurses. The survey instrument was the Nurses' Attitudes Regarding Physician Assisted Dying (NARPAD) Questionnaire. Of the 1210 surveys returned, 486 responded with narrative comments, including 64 (13%) hospice nurses. The comments were transcribed and read several times to identify key concepts which were coded and categorized. The categories were collapsed into three major themes that emerged for each question. The predominant theme in response to the vignette on suffering was beliefs. While a majority indicated acceptance of PAD in the context of suffering, their comments revealed many concerns about the process and the need to explore alternatives--especially to relieve pain and suffering. The predominant theme in response to both pain questions was barriers. Nurses indicated that effective pain control is possible but described numerous barriers. Discrepancies in provider knowledge and attitudes as well as access to expert pain care for all patients were identified as the primary barriers.