Advance Directives in Oncology: Reflexion about Evolution

1. Background summary

Neoplasias are pathologies of great frequency, which remain extremely severe despite therapeutic advances 1-5. Moreover, these pathologies and their treatments are responsible for a considerable fragilization of patients 6-14, favoring the occurrence of acute and severe conditions that may require specialized intensive care 15-28. However, the benefit of such interventions is uncertain, as they are futile in many cases 25,29-32. For this reason, knowledge of patients' values and preferences in the event of acute deterioration is of particular interest in this population. Advance directives could meet this imperative need for patient expression. Unfortunately, despite the years, the law offering such a possibility to the whole population, and notably to oncology and haematology patients, remains a dead letter. This can be explained on the one hand by a lack of information for patients, and on the other by clinicians' reluctance to use them.

2. Research objectives

2.1. Main objective

• Questionnaire-based measurement of barriers to information regarding advance directives by Oncology and Hematology physicians

2.2 Secondary objectives

• Measurement of perceived frequency of patient information regarding advance directives
• Measurement of perceived consideration of existing advance directives
• Search for factors associated with the realization of information regarding advance directives
• Search for factors associated with consideration of advance directives

3. Population of interest

The population of interest consists of all oncology or hematology physicians practicing in public or private care structures (particularly cancer centers).

4. Methodology

4.1. Questionnaire

The study questionnaire was constructed in accordance with the drafting recommendations for this type of instrument. The various themes addressed were determined by all the members of the REQUIEM group, as well as by the highlighting of certain critical elements observed during previous work.

The questionnaire was designed to be as comprehensive as possible

The questionnaire is divided into 5 areas:

• The clinician's involvement in providing information about the existence of advance directives
  • When to talk about it
  • Who should talk about it
  • Relevance of the legal provision "advance directives"
• Participation of the clinician in the drafting of advance directives
  • Relevance of drafting assistance
  • Information required for drafting
• Use of advance directives in acute situations when they exist
  • Use or lack of use and reasons for decision
• Information concerning the department where the respondent works
• Personal data concerning the respondent