MAID Forms Staging*

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Non-pharmacological management and patient self-management New

Non-pharmacological management

Salt intake

The quantity of salt in the diet should be adapted to the clinical situation, severity of symptoms and baseline consumption
The evidence base to support dietary salt restrictions is limited

Fluid intake

Strict limits on fluid intake (2L/day) should only be imposed when there is a clear fluid overload or demonstrated sensitivity to fluid intake
The evidence base to support fluid restrictions is limited and severely limiting intake may have adverse consequences

Alcohol consumption

Alcohol consumption should be limited for all patients with HF
Alcohol consumption should be avoided altogether if it is believed to be responsible or contributing to the syndrome

Smoking cessation

All attempts should be done to promote smoking cessation (smoking has been linked to the progression of coronary artery disease)
Nicotine replacement therapy and other smoking cessation therapies are acceptable
Refer patients for counselling

Physical activity

Support patients with NYHA HF types I-III to gradually increase regular physical activity to improve HF symptoms, quality of life of physical activity capacity (physical activity intolerance is recognized as a hallmark of HF)
Physical activity in patients with NYHA HF type IV should be supervised by experts
Aerobic activity: Start with 10-15 minutes 2-3 times/week, working way up to a goal of 30 minutes 5 times/week
Resistance activity: 10-20 repetitions with 5-10-pounds of weight, 2-3 times/week

Weight monitoring

Patient should weigh themselves every morning (after voiding and before breakfast), and record their weights
Patients should report weigh increases of ≥ 1kg per day or > 5kg per week

Patient self-management

Work in partnership with patients and caregivers to create a care plan.

Care plans should include information on the self-management strategies patients and caregivers should do and the frequency and include important resources for them to reference. Many patients will benefit from having clear instructions as opposed to multiple options based on a given situation. Consider discussing the potential options with the patient and caregiver before determining the instruction provided in their care plan.

Supporting your patient

Additional Community-based Mental Health Support

211Ontario: Regional community mental health centres, geriatric psychiatry services, and support groups.

Canadian Mental Health Association: 30 branches that provide community mental health services across Ontario.

ConnexOntario: Mental health system navigation and information. Mental health: 1-800-531-2600 | Addictions: 1-800-565-8603

eMentalHealth.ca: Directory of publicly funded regional service coordination and case management services.

Hope for Wellness: Mental health counselling and community-based cultural and emotional support for Indigenous people. 1-855-242-3310

Toronto based meditation and mindfulness programs

Talk4Healing: 24/7 talk, text, and chat to support Indigenous women by Indigenous women. 1-888-200-9997

thehealthline.ca: Regional mental health organizations, clinics, workshops, conferences, and support groups.

The Toronto Mental Health and Addictions Access Point: coordinated access to mental health and supportive housing agencies for residents living within the boundaries of Port Union Road to Highway 427 and Steeles Ave. to the lake.

Togetherall: Virtual community of anonymous support to help improve mental health and wellbeing. Free access through some organizations, colleges, and universities.

Educational Supports for Patients, Families, and Caregivers

Here to Help: Reading material about depression and anxiety disorders.

Informed Choices About Depression: Information about depression, types of treatment, and risks, benefits, and what to expect during treatment.

Mindfulness 101: Information about mindfulness and informal ways of practicing mindfulness everyday.

The anti-anxiety program: A workbook of proven strategies to overcome worry, panic, and phobias

Clinical Support for Providers

ECHO Ontario Mental Health: Virtual training and capacity building platform that links expert interdisciplinary teams with front line care providers.

Track One

MAID Track One: Patient inquiry

Patient inquires about MAID

Clinician chooses to participate in the discussion of MAID

Clinician chooses not to participate in the discussion of MAID

See Patient inquiries

Clinician chooses not to participate in the discussion of MAID

See Conscientious objections and patient referral
Clinician:

Informs the patient that they are unwilling to discuss MAID due to conscientious objections
Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID
Continue to provide ongoing care to the patient
Must report all requests for MAID. See federal reporting requirements for more information

Clinician chooses to participate in the discussion of MAID

See Discussion To Understand Motivation Behind Patient’s Inquiry About MAID
Clinician discusses and explores the motivation and suffering behind the patient’s request for MAID. The Clinician provides information on the available treatments and care options including MAID.
Note: Clinicians must report all requests for MAID even if it does not result in death. See federal reporting requirements for more information

After discussion of MAID with Clinician, Patient chooses:

To proceed with MAID eligibility assessments

Not to proceed with MAID eligibility assessments

Patient chooses NOT to proceed with MAID eligibility assessments

Patient chooses not to pursue MAID eligibility assessments at this time and chooses to explore alternate care options

Does Clinician choose(s) to participate in eligibility assessment?

Yes, Clinician chooses to participate in eligibility assessment

No, Clinician chooses not to participate in eligibility assessment

Clinician chooses NOT to participate in eligibility assessment

Clinician

Chooses not to participate in eligibility assessments and/or provision of MAID
Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID

Clinician chooses to participate in eligibility assessment

Continue to Assessment of patient eligibility and procedural safeguards

Track Two

MAID Track Two: Patient Inquiry

Patient inquires about MAID

Clinician chooses to participate in the discussion of MAID

Clinician chooses not to participate in the discussion of MAID

See Patient inquiries

Clinician chooses not to participate in the discussion of MAID

See Conscientious objections and patient referral
Clinician:

Informs the patient that they are unwilling to discuss MAID due to conscientious objections
Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID
Continue to provide ongoing care to the patient
Must report all requests for MAID. See federal reporting requirements for more information

Clinician chooses to participate in the discussion of MAID

After discussion of MAID with Clinician, Patient chooses:

To proceed with MAID eligibility assessments

Not to proceed with MAID eligibility assessments

Patient chooses NOT to proceed with MAID eligibility assessments

Patient chooses not to pursue MAID eligibility assessments at this time and chooses to explore alternate care options

Does Clinician choose(s) to participate in eligibility assessment?

Yes, Clinician chooses to participate in eligibility assessment

No, Clinician chooses not to participate in eligibility assessment

Clinician chooses NOT to participate in eligibility assessment

Clinician

Chooses not to participate in eligibility assessments and/or provision of MAID
Refers the patient to another Clinician, institution or agency (e.g. CCS) that is willing and able to provide MAID

Clinician chooses to participate in eligibility assessment

Continue to Assessment of patient eligibility and procedural safeguards

MAID Track Two: Assessment of patients eligibility

Clinician chooses to participate in eligibility assessment

Clinician conducts eligibility assessment for MAID (Clinician Aid B [for the Clinician assessing/providing MAID] and Clinician Aid C [for the Second Clinician]).

Eligibility criteria includes:

Is 18 years of age or older and has decision-making capacity.
Is eligible for publicly funded health care services
Has made a voluntary request that is not the result of external pressure. See
Has provided informed consent to receive MAID, meaning that the patient has consented to receive MAID after they have received all information needed to make this decision
Has a serious and incurable illness, disease or disability*
Is in an advanced state of irreversible decline in capability
Has enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable

* Patients whose only medical condition is a mental illness will not be eligible for MAID until March 2023

Does patient meet ALL eligibility criteria for MAID?

Yes, Patient meets ALL eligibility criteria for MAID

No, Patient does not meet eligibility criteria for MAID

Patient does NOT meet eligibility criteria for MAID

Communicate ineligibility to the patient and inform the patient of their right to consult a different Clinician to obtain another eligibility assessment

Patient meets ALL eligibility criteria for MAID

Clinician determines what procedural safeguard track the patient is on

Track One: Natural death is reasonably foreseeable

Track Two: Natural death is NOT reasonably foreseeable

Natural death is reasonably foreseeable

For more information on patients whose natural death is reasonably foreseeable, see the CEP’s resource on Track Two

Track Two: patients whose natural death is NOT reasonably foreseeable

Track Two procedural safeguards for patients whose natural death is NOT reasonably foreseeable:

Request for MAID must be made in writing. A written request must be signed by one independent witness, and it must be made after the patient is informed that they have a “grievous and irremediable medication condition” (Clinician Aid A)
Two independent Clinicians must provide an assessment and confirm that all eligibility requirements are met
If neither of the two Clinicians who assesses eligibility has expertise in the medical condition that is causing the patient’s suffering, they must consult with a Clinician who has such expertise
The patient must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care, and the patient must be offered consultations with available professionals who provide those services
The patient and the Clinicians must have discussed reasonable and available means to relieve the patient’s suffering and agree that the patient has seriously considered these means
The patient must be informed that they can withdraw their request at any time, in any manner

90-day assessment period The patient undergoes a 90-day assessment period*

The 90-day period begins on the day of the patient’s first MAID eligibility criteria assessment
The Clinician must document the start and end-date of the 90-day assessment
The Clinician must document if the period is shortened, why, and the new start and end-date

* This period can be shortened if both Clinicians are of the opinion that the loss of the patient’s capacity to provide consent to receive MAID is imminent and if both assessments have been completed Continue to Provision of MAID

MAID Forms Staging*

Non-pharmacological management and patient self-management New

Jump to:

Non-pharmacological management

Salt intake

Fluid intake

Alcohol consumption

Smoking cessation

Physical activity

Weight monitoring

Patient self-management

Talking Tips

Talking tips

Supporting your patient

Additional Community-based Mental Health Support

Educational Supports for Patients, Families, and Caregivers

Clinical Support for Providers

Track One

MAID Track One: Full pathway

Clinician chooses not to participate in the discussion of MAID

Clinician chooses to participate in the discussion of MAID

Patient chooses NOT to proceed with MAID eligibility assessments

Clinician chooses NOT to participate in eligibility assessment

Clinician chooses to participate in eligibility assessment

Patient does NOT meet eligibility criteria for MAID

Patient meets ALL eligibility criteria for MAID

Natural death is NOT reasonably foreseeable

Track One: Natural death is reasonably foreseeable

Provision of MAID

Clinician develops a plan for the administration of MAID, in consultation with the patient, and Designated facilities under the Trillium Gift of Life Network (TGLN) Act notify TGLN of the patient’s request for MAID when the patient’s death is imminent due to injury or disease

Clinician administers MAID

Clinician doe not provide MAID

Patient has decision-making capacity

Clinician does not provide MAID

Clinician provides MAID

Certification of Death and Reporting

Self-administered MAID with “advance consent for failed self-administration” written arrangement

Self-administered MAID WITHOUT “advance consent for failed self-administration” written arrangement

Patient self-administers MAID with no complications

Clinician administers MAID

Certification of Death and Reporting

Patient self-administers MAID with complications, and the Clinician cannot administer MAID

MAID Track One: Patient inquiry

Clinician chooses not to participate in the discussion of MAID

Clinician chooses to participate in the discussion of MAID

Patient chooses NOT to proceed with MAID eligibility assessments

Clinician chooses NOT to participate in eligibility assessment

Clinician chooses to participate in eligibility assessment

MAID Track One: Assessment of Patient Eligibility and Procedural Safeguards

Clinician chooses to participate in eligibility assessment

Patient does NOT meet eligibility criteria for MAID

Patient meets ALL eligibility criteria for MAID

Natural death is NOT reasonably foreseeable

Track One: Natural death is reasonably foreseeable

MAID Track One: Provision of MAID

Clinician administers MAID

Clinician doe not provide MAID

Patient has decision-making capacity

Clinician does not provide MAID

Clinician provides MAID

Certification of Death and Reporting

Self-administered MAID with “advance consent for failed self-administration” written arrangement

Self-administered MAID WITHOUT “advance consent for failed self-administration” written arrangement

Patient self-administers MAID with no complications

Clinician administers MAID

Certification of Death and Reporting

Patient self-administers MAID with complications, and the Clinician cannot administer MAID

Track Two

MAID Track Two: Full Pathway

Clinician chooses not to participate in the discussion of MAID

Clinician chooses to participate in the discussion of MAID

Patient chooses NOT to proceed with MAID eligibility assessments

Clinician chooses NOT to participate in eligibility assessment

Clinician chooses to participate in eligibility assessment

Patient does NOT meet eligibility criteria for MAID

Patient meets ALL eligibility criteria for MAID

Natural death is reasonably foreseeable

Track Two: patients whose natural death is NOT reasonably foreseeable

Provision of MAID

Clinician doe not provide MAID

Clinician develops a plan for the administration of MAID, in consultation with the patient, and
Designated facilities under the Trillium Gift of Life Network (TGLN) Act notify TGLN of the patient’s request for MAID when the patient’s death is imminent due to injury or disease