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Bull Cancer. 2013 Oct;100(10):941-5. doi: 10.1684/bdc.2013.1817.

[Advanced directives: nurses' and physicians' representations in 2012].

[Article in French]

Author information

  • 1Hospices civils de Lyon, centre hospitalier Lyon-Sud, centre de soins palliatifs, pavillon 1K, 165, chemin du Grand-Revoyet, 69495 Pierre-BĂ©nite cedex, France.


In cancer patients, decision-making process is crucial and patient's involvement is described as a central component. In 2005, a new tool appears to convey patient's opinion even if he is not able to communicate anymore: advanced directives (AD). Unfortunately, their documentation is marginal. The objective of this study was to investigate nurses' and physicians' representations towards AD. A questionnaire had been sent to hospitals, public health facilities and liberal practitioners during February 2012. We collected responses from 42/251 physicians (17 %) and 80/198 nurses (40 %). Sixty percent of participants reported that they were not familiar with the legislative framework for AD. For physicians, main barriers were patient cognitive impairment (P = 0.004) and lack of information on the clinical situation (P = 0.004). For nurses, difficulties were toward end of life and prognosis discussion (P = 0.002), clinical situation evolution since AD documentation (P = 0.008), time frame for AD application (P < 0.001) and the fact that final decision is made by physician alone (P = 0.015). AD should be part of a good medical practice and literature has highlighted the benefit of AD on patient's quality of life. End of life discussion therefore requires dedicated time and specific training for physicians and nurses to improve the rate of patients with AD.


advanced directives; cancer; decision-making

[PubMed - indexed for MEDLINE]
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