title: [Advance directives in dermato-oncology: The current situation and future prospects].
abstract: BACKGROUND
  Patient information and advance directives (AD) are described in the French laws of 4 March 2002 and 22 April 2005, which concern the decisions of subjects regarding end-of-life treatment. At present, practitioners rarely seek the opinion of patients on this matter. The Claeys-Leonetti law requires doctors to identify any advance directives by patients, which are binding upon medical staff. The present study sought to analyse the extent of application of the laws of 2002 and 2005 and to collect the observations of clinicians in dermato-oncology regarding the new legislation.
  
  
  METHODS
  We contacted members of the French dermato-oncology group by email and asked them to assess their practices with regard to information provision, patient surrogates and advance directives.
  
  
  RESULTS
  To 111 requests we received 34 replies from hospital dermatologists, i.e. a response rate of 31 %. In all, 85 % of clinicians informed patients with metastasis that their disease was incurable, and 94 % stated that they have procedures in place concerning the appointment of a patient surrogate. One third of respondents reported having a procedure in place for provision of information or collection of advance directives. According to 91 % of clinicians, the binding nature of advance directives did not constitute any loss of chance for the patient in question; 59 % felt that the new law would affect their practices, but of these, paradoxically, 60 % felt that this would have no impact on their therapeutic decision-making. In all, 26 clinicians (76.5 %) did not intend to modify their decision-making process.
  
  
  CONCLUSIONS
  The law of 2002 is generally better known than that of 2005. Dermato-oncologists are not aware of the practical consequences of the new binding nature of advance directives with regard to the doctor-patient relationship and the actual decision-making process.
authors.affiliation: Clinique dermatologique, faculté de médecine, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France; Laboratoire d'éthique médicale, université Paris Descartes, 45, rue des Saints-Pères, 75006 Paris, France. Electronic address: charles.velter@chru-strasbourg.fr.
authors.forename: C
authors.initials: C
authors.lastname: Velter
authors.affiliation: Clinique dermatologique, faculté de médecine, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
authors.forename: B
authors.initials: B
authors.lastname: Cribier
authors.affiliation: Service de cancérologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris (AP-HP), 123, boulevard de Port-Royal, 75014 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Goldwasser
authors.affiliation: Service de médecine palliative, hôpital Cochin, université Paris Descartes, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Vinant
mesh_terms: D016223:Advance Directives / Q000331:legislation & jurisprudence; D000072085:Dermatologists; D005602:France; D006801:Humans; D009369:Neoplasms; D010818:Practice Patterns, Physicians'; D019727:Proxy; D011795:Surveys and Questionnaires
keywords: Advance care planning; Advance directives; Directives anticipées; Information du patient; Living wills; Melanoma; Mélanome; Patient's informed treatment preferences; Personne de confiance; Préférences du patient; Surrogate