{"title":"Regards de médecins sur les directives anticipées en oncologie vingt ans après la loi Leonetti : constats et perspectives.","authors":"Roxane Delpech, Sébastien Lamy, Belén Jimenez, Nathalie Caunes-Hilary, Florence Taboulet, Bettina Couderc","doi":"10.3917/spub.pr2.0080","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Advance directives (ADs) allow any person of legal age to express their wishes regarding the conditions for administering, limiting, or withdrawing treatment if they become unable to express themselves. They were introduced in France in 2005 to give patients greater autonomy over their medical care, particularly at the end of life. However, patients make little use of ADs. The aim of this study was to evaluate the benefits of ADs for oncologists and their suggestions for improving the practical impact of the system.</p><p><strong>Method: </strong>Between January and April 2022, an anonymous survey was conducted via LimeSurvey with physicians from three UNICANCER centers and surgeons attending the 2022 French Society of Surgical Oncology (SFCO) congress. Comprising 27 questions, the survey aimed to analyze the use, perception, and expectations of physicians regarding ADs. The data were subjected to descriptive quantitative analysis and lexical analysis using IRaMuTeQ (Reinert method). A thematic sociological study was also carried out to identify trends based on medical specialties.</p><p><strong>Results: </strong>The results show that twenty years after the Leonetti Law, a large majority of oncologists are aware of the existence of ADs, find them useful, and would like to have access to them when making a serious decision for an unconscious patient. However, they also highlight the many barriers to their implementation. They explained that ADs rarely clarify the patient's wishes and were often unsuitable for the situations encountered.</p><p><strong>Discussion: </strong>These findings highlight the fact that ADs cannot replace ongoing discussions about end of life throughout the care pathway to support patients in their reflections. It is therefore important to encourage reflective work around these discussions rather than focusing solely on the production of a final document.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"37 3","pages":"145-160"},"PeriodicalIF":0.3000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Sante Publique","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3917/spub.pr2.0080","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Advance directives (ADs) allow any person of legal age to express their wishes regarding the conditions for administering, limiting, or withdrawing treatment if they become unable to express themselves. They were introduced in France in 2005 to give patients greater autonomy over their medical care, particularly at the end of life. However, patients make little use of ADs. The aim of this study was to evaluate the benefits of ADs for oncologists and their suggestions for improving the practical impact of the system.
Method: Between January and April 2022, an anonymous survey was conducted via LimeSurvey with physicians from three UNICANCER centers and surgeons attending the 2022 French Society of Surgical Oncology (SFCO) congress. Comprising 27 questions, the survey aimed to analyze the use, perception, and expectations of physicians regarding ADs. The data were subjected to descriptive quantitative analysis and lexical analysis using IRaMuTeQ (Reinert method). A thematic sociological study was also carried out to identify trends based on medical specialties.
Results: The results show that twenty years after the Leonetti Law, a large majority of oncologists are aware of the existence of ADs, find them useful, and would like to have access to them when making a serious decision for an unconscious patient. However, they also highlight the many barriers to their implementation. They explained that ADs rarely clarify the patient's wishes and were often unsuitable for the situations encountered.
Discussion: These findings highlight the fact that ADs cannot replace ongoing discussions about end of life throughout the care pathway to support patients in their reflections. It is therefore important to encourage reflective work around these discussions rather than focusing solely on the production of a final document.
期刊介绍：
La revue Santé Publique s’adresse à l’ensemble des acteurs de santé publique qu’ils soient décideurs,
professionnels de santé, acteurs de terrain, chercheurs, enseignants ou formateurs, etc. Elle publie
des travaux de recherche, des évaluations, des analyses d’action, des réflexions sur des interventions
de santé, des opinions, relevant des champs de la santé publique et de l’analyse des services de
soins, des sciences sociales et de l’action sociale.
Santé publique est une revue à comité de lecture, multidisciplinaire et généraliste, qui publie sur
l’ensemble des thèmes de la santé publique parmi lesquels : accès et recours aux soins, déterminants
et inégalités sociales de santé, prévention, éducation pour la santé, promotion de la santé,
organisation des soins, environnement, formation des professionnels de santé, nutrition, politiques
de santé, pratiques professionnelles, qualité des soins, gestion des risques sanitaires, représentation
et santé perçue, santé scolaire, santé et travail, systèmes de santé, systèmes d’information, veille
sanitaire, déterminants de la consommation de soins, organisation et économie des différents
secteurs de production de soins (hôpital, médicament, etc.), évaluation médico-économique
d’activités de soins ou de prévention et de programmes de santé, planification des ressources,
politiques de régulation et de financement, etc
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