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

Abstract

Background Among patients with cancer, discussion about the desired care is important, because progression of the disease, particularly signs of impaired consciousness, can lead to unwanted care in situations where no advance directives (ADs) have been provided. The aim of this study was to identify the most appropriate individual and time for addressing the subject of ADs with patients with cancer.Methods A systematic literature review was carried out between September 2014 and August 2015, using the following databases or sets of databases: PubMed, Web of Science, Cochrane Library, EM Premium, and the French database Public Health Data Bank. The methodological aspects of the articles were selected and evaluated with the help of PRISMA international guidelines.Results Of the 1170 articles identified, 7 were included (6 descriptive studies, 1 interventional study). A doctor was cited as the preferred individual for discussing the subject of advance directives with the patient. In 3 studies, this was listed as a general practitioner, whereas in the other 3 studies, it was an oncologist. The most opportune time was during the absence of a serious pathology (3 studies) and at the time the disease was diagnosed (2 studies).Conclusions Our results support the goals of Claeys-Leonetti, a 2016 French law concerned with the rights of patients receiving end-of-life care, and they suggest the implementation of a consultation for discussing and drafting ADs.