{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T14:40:46Z","timestamp":1792248046556,"version":"4.4.0"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Importance:<\/jats:title>\n                    <jats:p>Head and neck oncologists frequently manage patients with advanced malignancies and profound symptom burden. As medical assistance in dying (MAID) becomes more common in Canada, understanding Otolaryngology-Head and Neck Surgery (OHNS) surgeons\u2019 perspectives can help characterize practice patterns, perceived barriers, and educational needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To assess OHNS surgeons\u2019 reported willingness to discuss, assess, or provide MAID in the context of head and neck cancer care and to describe geographic heterogeneity in responses across standard Canadian regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>National cross-sectional survey distributed in August 2024 to active members of the Canadian Society of OHNS. The 19-question survey, developed by a medical student, resident, and surgeon, with expert review, assessed attitudes, experiences, barriers, and educational needs relating to MAID. Regions were defined as Atlantic (NL, PEI, NS, NB), Central (ON, QC), Prairies (MB, SK, AB), and West Coast (BC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>Forty-seven attending OHNS surgeons practicing in Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures:<\/jats:title>\n                    <jats:p>The primary outcome was variation in overall comfort with MAID across Canadian regions, based on a composite score incorporating comfort discussing MAID when death is foreseeable, not foreseeable, and willingness to administer it. Secondary outcomes included frequency of MAID discussions, willingness to provide second opinions or administer MAID, and factors influencing participation such as training and conscientious objection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Respondents were primarily from Central Canada (24\/47, 51%) and the Prairies (15\/47, 32%), with most practicing in academic or tertiary centers (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.04). Nearly half (22\/47, 47%) reported needing further training to feel comfortable discussing MAID. Support for conscientious objection was high (34\/47, 72%). Only 4% (2\/47) administer MAID as part of their practice, and only 13% (6\/47) had ever done so. Common barriers included limited comfort, experience, and exposure. Among the 51% (24\/47) of surgeons not routinely discussing MAID with terminally ill patients, 38% (9\/24) cited role limitations and 21% (5\/24) preferred referral to palliative care. Willingness to provide a second opinion varied across regions (60%-100%), though this was not statistically significant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.25).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>While most respondents support discussing MAID when death is reasonably foreseeable, few participate in its administration. Respondents most commonly identified training\/exposure, role delineation, and institutional processes as factors shaping involvement, and many endorsed referral-based pathways as appropriate. Larger studies with province-level analyses are needed to better characterize geographic variation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19160216261490916","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:56:45Z","timestamp":1792040205000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perceptions of Medical Assistance in Dying in Head and Neck Oncology in Canada: A National Survey Study"],"prefix":"10.1177","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7137-6393","authenticated-orcid":false,"given":"Alexandra","family":"Katz","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7594-4522","authenticated-orcid":false,"given":"Gabriel","family":"Dayan","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, Department of Surgery, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tareck","family":"Ayad","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, Department of Surgery, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Bissada","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, Department of Surgery, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos","family":"Christopoulos","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, Department of Surgery, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Jo","family":"Olivier","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, Department of Surgery, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Guertin","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, Department of Surgery, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1389-2151","authenticated-orcid":false,"given":"Justin","family":"Pyne","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0668-4381","authenticated-orcid":false,"given":"Carole","family":"Lambert","sequence":"additional","affiliation":[{"name":"Department of Radio-Oncology, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Tabet","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2014Head and Neck Surgery, Department of Surgery, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"Government of Canada. Canada\u2019s medical assistance in dying (MAID) law. 2026. Accessed October 1 2026. https:\/\/www.justice.gc.ca\/eng\/cj-jp\/ad-am\/bk-di.html"},{"key":"e_1_3_4_3_2","unstructured":"Government of Canada. Fourth annual report on Medical Assistance in Dying in Canada 2022. 2023. Accessed October 1 2026. https:\/\/www.canada.ca\/en\/health-canada\/services\/publications\/health-system-services\/annual-report-medical-assistance-dying-2022.html#table_3.1"},{"key":"e_1_3_4_4_2","article-title":"Experiences and perspectives of people who pursued medical assistance in dying: qualitative study in Vancouver, BC","volume":"64","author":"Nuhn A","year":"2018","unstructured":"Nuhn A, Holmes S, Kelly M, Just A, Shaw J, Wiebe E. Experiences and perspectives of people who pursued medical assistance in dying: qualitative study in Vancouver, BC. Can Fam Physician. 2018;64:e380-e386.","journal-title":"Can Fam Physician"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2022.6549"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2007.02.006"},{"key":"e_1_3_4_7_2","unstructured":"Government of Canada. Medical assistance in dying: implementing the framework. 2024. Accessed October 1 2026. https:\/\/www.canada.ca\/en\/health-canada\/services\/health-services-benefits\/medical-assistance-dying\/implementing-framework.html"},{"key":"e_1_3_4_8_2","unstructured":"Government of Canada. Model practice standard for medical assistance in dying (MAID). 2023. Accessed October 1 2026. https:\/\/www.canada.ca\/en\/health-canada\/services\/publications\/health-system-services\/model-practice-standard-medical-assistance-dying.html#a8"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/ijph.2024.1607407"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216320968517"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1586\/erp.11.102"},{"key":"e_1_3_4_13_2","volume-title":"Studio: Integrated Development Environment for R","author":"RStudio Team","year":"2022","unstructured":"RStudio Team. Studio: Integrated Development Environment for R. RStudio, PBC; 2022."},{"key":"e_1_3_4_14_2","article-title":"Medical-ethical guidelines: management of dying and death","volume":"148","author":"Swiss Academy of Medical Sciences","year":"2018","unstructured":"Swiss Academy of Medical Sciences. Medical-ethical guidelines: management of dying and death. Swiss Med Wkly. 2018;148: w14664.","journal-title":"Swiss Med Wkly"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.109-5345"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/23821205241272376"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11162305"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2019-001903"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-087736"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951519000518"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2018-105160"}],"container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19160216261490916","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19160216261490916","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19160216261490916","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T13:46:17Z","timestamp":1792244777000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19160216261490916"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":20,"alternative-id":["10.1177\/19160216261490916"],"URL":"https:\/\/doi.org\/10.1177\/19160216261490916","relation":{},"ISSN":["1916-0216","1916-0216"],"issn-type":[{"value":"1916-0216","type":"print"},{"value":"1916-0216","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"article-number":"19160216261490916"}}