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. 2024 Apr 10;25(1):44.
doi: 10.1186/s12910-024-01046-8.

Oncologists' perspective on advance directives, a French national prospective cross-sectional survey - the ADORE study

Amélie Cambriel  1   2   3   4 , Kevin Serey  5   4 , Adrien Pollina-Bachellerie  6   4 , Mathilde Cancel  7 , Morgan Michalet  8 , Jacques-Olivier Bay  9   10 , Carole Bouleuc  11 , Jean-Pierre Lotz  12   4 , Francois Philippart  13   14
Affiliations

Oncologists' perspective on advance directives, a French national prospective cross-sectional survey - the ADORE study

Amélie Cambriel et al. BMC Med Ethics. .

Abstract

Background: The often poor prognosis associated with cancer necessitates empowering patients to express their care preferences. Yet, the prevalence of Advance Directives (AD) among oncology patients remains low. This study investigated oncologists' perspectives on the interests and challenges associated with implementing AD.

Methods: A French national online survey targeting hospital-based oncologists explored five areas: AD information, writing support, AD usage, personal perceptions of AD's importance, and respondent's profile. The primary outcome was to assess how frequently oncologists provide patients with information about AD in daily clinical practice. Additionally, we examined factors related to delivering information on AD.

Results: Of the 410 oncologists (50%) who responded to the survey, 75% (n = 308) deemed AD relevant. While 36% (n = 149) regularly inform patients about AD, 25% (n = 102) remain skeptical about AD. Among the respondents who do not consistently discuss AD, the most common reason given is the belief that AD may induce anxiety (n = 211/353; 60%). Of all respondents, 90% (n = 367) believe patients require specific information to draft relevant AD. Physicians with experience in palliative care were more likely to discuss AD (43% vs 32.3%, p = 0.027). Previous experience in critical care was associated with higher levels of distrust towards AD (31.5% vs 18.8%, p = 0.003), and 68.5% (n = 281) of the respondents expressed that designating a "person of trust" would be more appropriate than utilizing AD.

Conclusion: Despite the perceived relevance of AD, only a third of oncologists regularly apprise their patients about them. Significant uncertainty persists about the safety and relevance of AD.

Keywords: Advance directives; Cancer; Ethics; Oncologist; Trust person; Tumor.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Geographical distribution of respondents
Fig. 2
Fig. 2
Frequency of Advance directive’s mention
Fig. 3
Fig. 3
Timing for initiating a discussion on advance directives. Numbers are expressed in % (absolute value) of respondents to the survey. Respondents were allowed to choose multiple answers
Fig. 4
Fig. 4
Reasons to avoid talking advance directives with a patient. Numbers are expressed in % (absolute value) of respondents to the survey. Respondents were allowed to choose multiple answers
Fig. 5
Fig. 5
Oncologists perception of advance directives
Fig. 6
Fig. 6
Necessity and type of additional information on AD. Numbers are expressed in % (absolute value) of respondents to the survey. Respondents were allowed to choose multiple answers
See this image and copyright information in PMC

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