[Euthanasia: a mixed-methods study on referents' experience in Catalonia]

To identify strengths and challenges in the provision of assistance in dying (PAM) based on the experiences of the Catalan Health Institute (ICS) euthanasia referents.

Mixed-methods study (n=31), using two closed-ended questionnaires (quantitative analysis) and two structured interviews with open-ended fields (qualitative analysis), self-administered via email. All ICS referents (n=50) received them. The first questionnaire (n=31) and interview (n=12) were addressed to all referents. The second questionnaire (n=7) and interview (n=6) were directed only to those who had also directly participated in a PAM. The results were triangulated and are presented as an integrated analysis.

From the integration of quantitative and qualitative responses, six thematic blocks emerged: 1) dedication and compensation; 2) training; 3) weak points and difficulties; 4) emotional and psychological impact; 5) considerations on end-of-life issues; and 6) motivations and advice from contacts. From the joint analysis, proposals for improvement were concluded: compensate for the workload that PAM implies, improve training, ensure that conscientious objection is in accordance with the law, and review aspects of the LORE, as procedures, deadlines, interdisciplinarity, ambiguities, and excluded cases. It was established: the usefulness of the referent role; respecting patient autonomy offsets negative emotions in professionals; PAM promotes reflection on the purposes of medicine.

Euthanasia referents' experiences can guide other professionals and suggest guidelines for institutional leaders and health managers.