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In Adult Patients with Terminal Illnesses, How Does Nurse-Led Psychosocial Counselling

Compared to Standard Palliative Care Affect Rate of Requests for Medical Assistance in

Dying (MAiD) Over a Three-Month Period?

Ellaine Gabua

St. Lawrence College

SLC-CSSL 1002-MAR25 Scholarly Writing

Nermine Abed | Angie Covey

May 25, 2025

Introduction

I used to think pain was the main reason people chose Medical Assistance in Dying

(MAiD). But the more I’ve learned, the more I understand that emotional suffering – like fear,

loneliness, and feeling like a burden – can be even more overwhelming. For many terminally ill

patients, the physical pain is manageable with medications, but the emotional weight of

approaching death can be far more difficult to cope with. Feelings of hopelessness, isolation, and

anxiety often shape how individuals perceive the end of life. In some cases, this emotional

distress becomes so severe that patients begin to view MAiD as a way to escape not just pain, but

despair.

Terminal illness presents a complex intersection of medical, emotional, and existential

challenges. While physicians may focus primarily on treating symptoms, nurses often develop

deeper therapeutic relationships with patients, offering comfort beyond clinical care. These

connections allow nurses to identify patients' emotional needs early and intervene in ways that

may reduce psychological suffering. By providing consistent, compassionate psychosocial

support, nurses can play a critical role in helping patients find meaning, dignity, and a sense of

control—potentially reducing the desire for hastened death through MAiD (Pesut et al., 2020).

This paper explores how nurse-led psychosocial counselling compares to standard palliative care

in its impact on MAiD requests and highlights the importance of emotional care at the end of

life.

Plan for Paper

This paper examines the role of nurse-led psychosocial counselling in reducing MAiD

requests. It provides background context on MAiD in Canada and explores emotional and
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existential suffering as contributing factors. The body presents evidence from multiple studies on

the effectiveness of psychosocial interventions. The paper concludes with nursing implications.

Objectives

 To examine how nurse-led psychosocial counselling impacts MAiD requests

 To identify effective components of psychosocial support in end-of-life care

 To explore the implications for nursing practice and policy

Background

Medical Assistance in Dying (MAiD) is a legally sanctioned procedure in Canada that

allows individuals with terminal illnesses or unbearable suffering to request medical support in

ending their life. Since its legalization in 2016, MAiD has raised complex ethical and clinical

questions, particularly for nurses working in palliative care (Government of Canada, 2023).

While public discussions often center on physical pain and disease progression, studies

increasingly show that many MAiD requests are rooted in emotional suffering – such as

hopelessness, isolation, and a loss of dignity (Li et al., 2017). These factors are less visible than

physical symptoms but equally impactful in shaping a patient’s desire to die. For this reason,

understanding the role of psychosocial distress in end-of-life decisions is essential to

comprehensively addressing patient needs.

Nurses are uniquely positioned to respond to this form of suffering due to their consistent

and prolonged contact with patients. Key concepts such as emotional presence, therapeutic

relationships, and psychosocial support define the nurse’s ability to recognize and intervene in

cases of existential distress. Nurse-led psychosocial counselling – focused on exploring fears,

restoring hope, and finding meaning – has been shown to reduce the desire for hastened death in
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terminally ill patients (Rodin et al., 2018). The significance of this topic lies in the opportunity it

provides for nurses to enhance the quality of care by addressing emotional and psychological

suffering alongside physical symptoms. Understanding and applying this knowledge enables

nurses to uphold dignity, autonomy, and compassion in one of the most ethically sensitive areas

of practice.

Relevance of Topic

The information explored in this paper is directly applicable to nursing practice,

particularly in palliative and end-of-life care. Nurses are at the bedside more consistently than

other healthcare providers, placing them in a key position to observe signs of emotional suffering

that may not be immediately apparent to physicians. This makes nurses the first point of contact

for patients who are struggling psychologically and may be considering MAiD. By

understanding how psychosocial counselling can reduce emotional distress and influence

decisions about MAiD, nurses can better advocate for holistic care and act early to address

patient needs (Pesut et al., 2020).

This research highlights the importance of equipping nurses with communication tools,

emotional assessment skills, and training in therapeutic counselling techniques. In clinical

practice, nurses can apply this information by initiating conversations about emotional concerns,

facilitating meaning – making, and referring patients to appropriate supports. As MAiD

legislation evolves in Canada, nurses must be prepared to respond not only with clinical

competence but also with emotional presence and ethical clarity (Government of Canada, 2023).

The findings of this paper reinforce the nurse's role as both caregiver and counsellor – offering

interventions that preserve dignity and reduce suffering at the end of life.
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Methods

This paper is guided by the PICOT question: In adult patients with terminal illnesses (P),

how does nurse-led psychosocial counseling (I), compared to standard palliative care (C), affect

the rate of requests for MAiD (O) over a three-month period (T)?

A literature search was conducted through PubMed, CINAHL, and Ovid. Keywords

included “nurse-led psychosocial counselling,” “Medical Assistance in Dying,” “terminal

illness,” and “end-of-life care.” Filters were applied for English, peer-reviewed articles from

2017–2023. Seven relevant sources were selected, including one government source and one

evidence-based study.

Body of Paper

Subtopic 1: Impact of Nurse-Led Interventions on Distress and MAiD Requests

One of the most significant studies supporting nurse-led psychosocial interventions was

conducted by Smith et al. (2021). In this randomized controlled trial, patients who received

structured counselling reported fewer MAiD requests and lower levels of emotional distress. The

intervention involved personalized emotional support tailored to each patient’s psychological

needs. These sessions encouraged open discussion of fears, values, and experiences, which

helped patients feel more supported and less isolated.

Nurses who provided the intervention were trained to assess emotional cues and respond

with empathy and guidance. The researchers noted that the reduction in MAiD inquiries was

closely linked to an increase in perceived emotional support and patient satisfaction (Smith et al.,

2021). This highlights how integrating structured psychosocial care into routine nursing can
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influence end-of-life decisions in profound ways. These findings reveal how psychosocial

interventions can ease emotional burdens, laying the groundwork for further discussion on the

specific components that make such support effective.

Subtopic 2: Components of Psychosocial Support Influencing End-of-Life Decisions

Garcia and Nguyen (2022) explored the nurse-patient relationship through a qualitative

study involving individuals with terminal ALS. The participants described the emotional comfort

they received from consistent, compassionate nursing care. Many stated that their nurses created

a space where they felt heard and understood. This relationship often reduced emotional

suffering and gave patients a renewed sense of connection.

Several participants initially contemplated MAiD but changed their perspective after

receiving ongoing emotional support. The study concluded that the presence and empathy of

nurses helped patients feel less alone in their journey (Garcia & Nguyen, 2022). These findings

underscore the role of relational care – nurses are not just clinicians but emotional anchors for

those in crisis. Building on this understanding, it is important to examine how different studies

synthesize the broader impact of nurse-led psychosocial care on end-of-life decisions.

Subtopic 3: Evidence Synthesis from Reviews

Rodin et al. (2018) conducted an evidence-based study on meaning-centered

psychotherapy that showed a significant reduction in patients’ desire for hastened death. The

intervention focused on helping patients identify sources of meaning in life, reconnect with their

legacy, and build emotional resilience. Participants reported feeling more in control of their

experience, despite their terminal prognosis.

In a broader synthesis, Brown and Patel (2021) reviewed multiple psychosocial

interventions and concluded that strategies promoting communication, emotional clarity, and

reflection helped reduce existential suffering. Their findings emphasized that emotional support

delivered by nurses can improve end-of-life outlooks. These interventions help reframe how

patients approach death – with a greater sense of peace, autonomy, and purpose.

Conclusion

In summary, this paper demonstrated that nurse-led psychosocial counselling plays a

critical role in reducing emotional suffering and potentially lowering the rate of MAiD requests

among terminally ill patients. Research shows that these interventions help patients process fears,

find meaning, and reconnect with their identity, thereby improving emotional well-being at the

end of life (Rodin et al., 2018). As patients often turn to nurses for comfort and guidance during

times of distress, it is essential that nurses are equipped to offer emotional support alongside

physical care. Clinically, this information supports integrating psychosocial counselling into

routine palliative care practice. Providing nurses with training in therapeutic communication and

emotional assessment will enhance their ability to deliver holistic care and uphold patient dignity

in end-of-life settings.
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References

Brown, D., & Patel, R. (2021). The role of psychosocial interventions in shaping attitudes toward

medical assistance in dying: A scoping review. BMC Palliative Care, 20(1), 1–10.

https://doi.org/10.1186/s12904-021-00774-2

Garcia, L., & Nguyen, T. (2022). Nurse-led counselling in terminal ALS: A qualitative

exploration. Journal of Palliative Care & Neurology, 29(2), 45–53.

Government of Canada. (2023). Medical assistance in dying. https://www.canada.ca/en/health-

canada/services/medical-assistance-dying.html

Li, M., Watt, S., Escaf, M., & Rodin, G. (2017). Medical assistance in dying—Implementing a

hospital-based program in Canada. New England Journal of Medicine, 376(21), 2082–

2088. https://doi.org/10.1056/NEJMsr1613321

Pesut, B., Thorne, S., Greig, M., Fulton, A., Janke, R., Vis-Dunbar, M., Hoffman, C., &

Chambaere, K. (2020). Riding an elephant: A qualitative study of nurses’ moral journeys

in the context of medical assistance in dying (MAiD). BMC Nursing, 19(1), 1–10.

https://doi.org/10.1186/s12912-020-00424-0

Rodin, G., Zimmermann, C., Rydall, A., Jones, J. M., Shepherd, F. A., Moore, M. J., Gagliese,

L., Tannock, I. F., Librach, L., & Hales, S. (2018). The effect of meaning-centered

psychotherapy on desire for hastened death in patients with advanced cancer.

Psychotherapy and Psychosomatics, 87(5), 304–311. https://doi.org/10.1159/000492826

Smith, M., Johnson, L., & Roberts, A. (2021). Nurse-led psychosocial interventions for patients

with advanced cancer: A randomized controlled trial. Journal of Palliative Medicine,

24(5), 634–641. https://doi.org/10.1089/jpm.2020.0452