"Let's talk about it! initiating Discussions Dedicated to Anticipation.

Problematic: Information expectations and preferences for involvement in decisions assessed in patients with advanced cancer, prompt more active proposal of a discussion process anticipating worsening. In view of Anglo-Saxon experiences with "Advance Care Planning" and studies that have evaluated its impact, the process of anticipating end-of-life preferences must be integrated into a progressive and dynamic system of Discussions Dedicated to Anticipation (DDA), and the strictly numerical objective of writing advance directives or designating a trusted person is not a relevant criterion for assessing its effect.

The "Et Si On En Parlait... " meets 4 objectives: 1) To characterize, among patients with advanced cancer, the profile of those who take up a DDA proposal and engage in the discussion process; 2) To analyze the causes of refusal to participate; 3) To assess the subjective effects of the intervention on the patient and the investigating professionals (qualitative approach); 4) To evaluate the intensity of care at the end of life, as a function of engagement in the DDA process.

The "Et Si On En Parlait..." study is based on a qualitative approach

Method: Prospective, monocentric, mixed-methodology study aiming to include, from December 2019, 240 patients with advanced-stage metastatic cancer with an oncologist-estimated life expectancy of 1 year. The intervention takes place in 2 interviews conducted by an investigator pair, doctor and nurse from the mobile palliative care team: assessment of the patient's wishes in terms of information and participation in decisions (API) and anxiety-depressive state (HADS) (E1), then interview initiating a DDA with the patient (E2), based on the "Et Si On En Parlait..." information booklet designed for the study.

The effects of the intervention will be evaluated quantitatively on 1/ the patient's degree of engagement in the process (combining his response to the proposal for a transmission to the oncologist and the attending physician and a 3rd interview continuing the process, the formalization of his wishes in the medical record or in the form of advance directives, the effective pursuit of DDAs with doctors, assessed up to 6 months after E2), 2/ the usefulness and necessity of this approach perceived by the patient, 3/ the level of anxiety generated at the end of E2.

Qualitative evaluation will be based on verbatims collected during E1 and E2, and, for 20 patients, during a clinical interview with a psychologist, dedicated to collecting the patient's impressions of the previous interviews.

Results/Conclusion: The preparation of this study has already led the EMSP to work together and with the oncology psychologists around the design of the "Et Si On En Parlait..." booklet. Implementing the study will provide useful data on professionals' experience of appropriating the DDA approach. Its results will help identify patients who would potentially benefit from DDA and those, on the contrary, whom these discussions could destabilize.