A/Prof. Rebecca Disler1,2, Dr Edward Zimbudzi1, Dr Anthoy May1, Emma Patterson1, Michelle Baird3, Dr Venise Hon1, Dr Auxillia Madhuvu1, Dr Katrina Recoche1, Dr Kaori Shimoinaba1, Dr Kristen Glenister2, Dr Helen Hickson4, Professor Doranne Donesky5, Professor Jennifer Philip2,6
1Monash University, Melbourne, Australia, 2The University of Melbourne, Melbourne, Australia, 3Chronic and Complex Care, Western NSW Local Health District, Australia, 4Central Queensland University, Australia, 5University of California San Francisco, San Francisco, USA, 6St Vincent’s Hospital Melbourne, Fitzroy, Australia
Biography:
A/Professor Rebecca Disler, ARC DECRA Fellowship at Monash, is a leading clinical researcher and registered nurse, driving improvement in access and models of care for people with chronic and palliative conditions, particularly in rural communities. As Fellow of American Thoracic Society, Thoracic Society of ANZ, and member of the Lung Foundation Australia COPDX Guideline committee, her work is incorporated in multiple international guidelines, including NICE UK and Global chronic lung disease strategy documents.
Abstract:
Background:
End-of-life discussions remain under-represented in heart, lung and kidney disease, despite significant physical, psychological, and existential challenges. Discussions about voluntary assisted dying (VAD) may serve as important entry-points to foster end-of-life dialogue in populations that have historically had limited access to such conversations. However, clinician confidence and preparedness to engage in VAD conversations is low, and factors influencing clinician perspectives remain poorly understood.
Aims:
This study applied the Theoretical Domains Framework (TDF) to explore chronic-disease clinicians' views around VAD conversations and to identify strategies to foster ongoing, values-based dialogue.
Methods:
A national anonymous cross-sectional survey of Australian doctors, nurses, and allied health professionals involved in lung, heart, and kidney disease was conducted via snowball sampling and organizational emails. Thematic analysis of free-text responses, guided by the TDF, explored factors influencing clinicians’ perspectives, including hesitancies, patient and personal challenges, rural access, and recommended facilitators.
Results:
Respondents (n=189; 98% of the survey cohort) were mostly female (88%), +40 years old, with +10 years’ experience. 70% were nurses and many worked across multiple conditions (38%) or specifically in lung, kidney or heart disease (29%, 23%, 11%). VAD had been raised with 56% of respondents, however 44% reported no VAD training.
Five domains influenced perspectives: own and community knowledge; hesitations related to professional role and identity; beliefs about consequences (e.g. patient or family distress); organisational and environmental barriers (e.g. workplace culture); and social influences (personal beliefs and perceptions of patient/family values).
Conclusion:
VAD conversations offer valuable entry-points for end-of-life dialogue in groups that have historically had limited access to end-of-life planning. Clinicians working in chronic disease are frequently approach around VAD, yet interrelated knowledge, ethical, professional, and systemic concerns constrain open discussions. Targeted training and supportive organisational environments are needed to help clinicians recognise and use these moments to foster meaningful end-of-life dialogue.
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