[Respecting patient's end of life wishes: feasibility study of an information on surrogate and advance directives].
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.
AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75679 Paris cedex 14, France.
Pascale
P
Vinant
AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75679 Paris cedex 14, France; Université de Paris Descartes, 75006 Paris, France; AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, service d'oncologie médicale, 75679 Paris cedex 14, France.
Isabelle
I
Rousseau
Université de Paris Descartes, 75006 Paris, France; AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, service d'oncologie médicale, 75679 Paris cedex 14, France.
Olivier
O
Huillard
Université de Paris Descartes, 75006 Paris, France; AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, service d'oncologie médicale, 75679 Paris cedex 14, France.
François
F
Goldwasser
AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75679 Paris cedex 14, France.
Marie-Yvonne
MY
Guillard
AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75679 Paris cedex 14, France; Université de Paris Descartes, 75006 Paris, France. Electronic address: isabelle.colombet@cch.aphp.fr.
Isabelle
I
Colombet
D000328:Adult; D024362:Advance Directive Adherence / Q000523:psychology* / Q000706:statistics & numerical data; D001007:Anxiety / Q000175:diagnosis; D003142:Communication; D004067:Digestive System Neoplasms / Q000401:mortality / Q000523:psychology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008175:Lung Neoplasms / Q000401:mortality / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D057240:Patient Preference; D011446:Prospective Studies; D019727:Proxy / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*
Advance care planning; Advance directives; Advanced cancer; Cancer avancé; Directives anticipées; Discussions anticipées; Information du patient; Living wills; Patient's informed treatment preferences; Personne de confiance; Préférences du patient; Surrogate