Grant: Knowledge Synthesis Grant

Recent legal and political developements have put end-of-life policies at the forefront of Canadian debates. Comparative international studies could inform public deliberations, but making sense of international evidence is difficult because of inconsistent definitions and contextual health system differences. This systematic review will address the following questions: 1) What are the effects of public policies on changes in medical end-of-life practices; 2) What is known of the effects of policies on different patient groups; 3) How do differences in context between countries influence the effects of policies? We will search three electronic databases to identify studies comparing medical practices between countries with different policies, or within a single country before-and-after a change in policy. We developed a classification of medical end-of-life practices that distinguishes practices with different international legal status. We will compare the frequency of medical practices in countries with different public policies, or within countries before-and-after a change in policy. We will analyze variations in practices among different patient groups, and among countries with different contextual characteristics. Reserch objectives were established in collaboration with key organizations in Canada. Four deliberation meetings in two Canadian provinces will be conducted with policymakers, health professionals, and citizens to discuss the interpretation of findings and its implications for the canadian context. Communication of results will use publicly-accessible publications and plateforms. Our team brings together international experts in medicine, ethics, law, health policy, community psychology, social science, and systematic review methods. This systematic review has the potential to support better informed democratic deliberation on end-of-life policies in Canada.