Clinician readiness to respond to voluntary assisted dying queries in chronic heart, lung and kidney disease: Qualitative analysis.

BACKGROUND

End-of-life discussions remain under-represented in chronic heart, lung and kidney disease despite significant physical, psychological and existential burden. Voluntary assisted dying (VAD) discussions may represent valuable openings for dialogue about suffering, unmet need and care preferences in populations with limited access to such conversations. However, clinician confidence and preparedness remain low, and influencing factors are under-examined.

AIMS: Informed by the Theoretical Domains Framework (TDF), this study aimed to explore chronic disease clinicians' views on VAD conversations and strategies to support open, values-based dialogue.

METHODS

A national anonymous survey of Australian doctors, nurses, and allied health professionals working in lung, heart, and kidney disease was distributed via organisational emails and snowballing. Thematic analysis of free-text responses explored clinicians' perspectives, perceived challenges, and facilitators regarding engagement in VAD discussions.

RESULTS

Participants (n=189; 98% of survey cohort) were predominantly nurses (70%), female (88%), aged ≥40 years, with ≥10 years' experience. 38% worked across multiple conditions; others in lung, kidney or heart disease (29%, 23%, 11% respectively). VAD was raised by patients/family with 56% of participants, however, 44% reported no VAD training. VAD-related conversations were constrained by interrelated influences across five TDF domains: own/community knowledge; perceived professional role and identity; beliefs about consequences; organisational/workplace culture; social influences.

CONCLUSION

VAD conversations are common, but intersecting knowledge, ethical, professional, and systemic influences may lead clinicians to avoid or defer VAD queries. Targeted training and supportive organisational environments are needed to equip clinicians, particularly chronic disease nurses, to foster these moments for broader end-of-life dialogue.