Regards de médecins sur les directives anticipées en oncologie vingt ans après la loi Leonetti : constats et perspectives

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.

Keywords: Advance directives; advance care planning; end-of-life decision-making process; medical practices; patient autonomy.