Oncologists’ perspective on Advance Directives, a French national prospective cross-sectional survey – the ADORE Study

Abstract

Abstract Background The foreseeable severity of the prognosis of cancer invites to offer patients the possibility to express their values for care management. However, the prevalence of advance directives(AD) among oncology patients remains low. The aim of this study was to measure the interests and limits to the implementation of AD from the perspective of oncologists. Methods French national online survey of hospital-based oncologists. The questionnaire was composed of 5 domains: information on AD, redaction assistance, usage of AD, personal perception of the interest of ADs and clinical particularities of the respondent. Primary outcome was the reported frequency of patients’ information about existence of AD. Secondary outcomes were the measure of factors associated and barriers to the provision of AD information. Results 410 oncologists (50%) responded to the survey. 75% (n = 308) considered AD as a relevant tool. 36% (n = 149) regularly inform their patients. 25% (n = 102) remain suspicious of this provision, either because they see it as a source of anxiety (n = 211; 60%) or that patients require specific information to write relevant AD (n = 367; 90%). Experience in palliative care was associated with more frequent approach of AD (43% vs 32.3%, p = 0.027). Previous experience of critical care was associated with higher levels of AD distrust (31.5% vs 18.8%, p = 0.003). 68.5% (n = 281) of respondents considered a person of trust more appropriate than AD. Conclusion Although AD are mostly considered as a relevant tool, only one third of oncologists regularly inform their patients about them. Uncertainty about the safety and relevance of AD remain high.