Respect des volontés en fin de vie : étude de faisabilité d’une information sur la personne de confiance et les directives anticipées

Abstract

This prospective interventional study aims to show the feasibility and impact of information procedure on surrogate and advance directives (AD), for patients with incurable lung or gastrointestinal cancer. The intervention consisted of two semi-structured interviews. The first included: collection of preferences for prognostic information and involvement in decision-making, initial assessment of knowledge, information and surrogate and DA. The second assessed the impact of the first interview on knowledge, surrogate designation and DA writing, the assessment procedure by the patient and assessment of anxiety generated. Among 77 eligible patients, 23 (30 %) were included, 6/29 (21 %) refused to participate, 20/23 (87 %) completed both interviews. Patients not included had a higher 4-month death rate than included ones (39 % vs. 4 %, P=0.002). Patients included had high expectations of information and appreciated it be delivered early, by someone not involved in their care. The study shows the feasibility of the procedure and its impact on the use of surrogate and DA by patients, however, revealing the complexity of approaching end-of-life wills and the importance of a process of anticipated discussion.

Who Should Discuss Advance Directives With Patients With Cancer and When? A Systematic Literature Review

“…It should be noted that 3% (2/75) chose their surgeon. This result is in line with a study by Vinant et al [22] in which 2 out of 20 patients indicated that they preferred that this information be delivered by their oncologist. Likewise, in a study by Sahm et al [23], to the question "who should initiate the discussion about drafting ADs?"…”

“…However, ironically, of those patients, 87% (47/54) approved of the idea that the doctor admitting the patient to the hospital could discuss ADs with the patient during the admission process. Likewise, in the study by Vinant et al [22], several individuals agreed that the professional required to give information about ADs should not be involved in his or her care. In contrast, in the study by Sahm et al [23], in response to the question "who should initiate the discussion about drafting ADs?"…”

“…In the study by Vinant et al [22], some patients insisted that the professional prove their competence with regard to legal provisions and in the communication eld. Finally, in the study by Dow et al [21], when 75…”

Validity of the French version of the Autonomy Preference Index and its adaptation for patients with advanced cancer

“…� I would rather the decision be left to me, after having taken my doctor's advice into consideration 24 (13) � I would rather decide together with my doctor 71 (38) � I would prefer to let my doctor decide, once my opinion has been taken into consideration 56 (30) � I would prefer to let my doctor decide alone 30 (16) � Missing 1 (0)…”

“…For that matter, the need for an assessment of these patient's preferences has been highlighted in the literature [4,13,14]. To our knowledge, three measurement tools aiming to assess both information preferences and the desire to participate in decision-making have already been used among patients with incurable or terminal cancer: 1) visual analog scales initially developed for patients in emergency wards [15,16], 2) the Krantz Health Opinion Survey, a self-administered 16-item questionnaire, initially developed for students, and concerning medical care in general with a focus on self-medication [17,18], and 3) the Autonomy Preference Index (API), a self-administered 23-item questionnaire, initially developed for patients in primary care settings [19].…”