[Oncologists and hematologists' perspective on advance directives. A French national survey].

Abstract

Background: The prevalence of cancers and hematological malignancies is high and continues to grow. The severity of these pathologies calls for patients to be given the opportunity to express their values, particularly with regard to the intensity of treatment and the type of care they wish to receive. However, the prevalence of advance directives (ADs) in this population remains low. The aim of our study was to assess the perception of advance directives by French oncologists and hematologists, and their involvement in the promotion and use of these directives.

Methods: Observational, cross-sectional study based on an online questionnaire sent to the population of interest.

Results: Four hundred and ten oncologists (50.1%) and 318 haematologists (33.7%) completed the questionnaire. In total, 65.9% of oncologists and 68.9% of hematologists were attending physicians or equivalent. ADs were systematically or frequently offered to the patients by 38.4 and 30.7% of oncologists and hematologists, respectively. The main limitations to mentioning ADs were the fear of creating anxiety in patients (oncologists: 74.6% and hematologists: 64.4%) and the stability of the disease (32.9 and 54.1%). ADs were perceived as unhelpful or even dangerous by 24.9 and 27.4%. Finally, 68.5 and 67.3% considered that the trusted support person could be more relevant than ADs.

Conclusion: The majority of hematologists and oncologists consider that ADs may be useful. However, only a third of practitioners mention them regularly. The main reason for avoiding discussions about ADs was the fear of creating anxiety.