"I think it's a bit early for now": impact of psychological factors on drafting advance directives among cancer patients Running title: Advance directives for cancer patients

Patrice Cannone (1) , Pascale Tomasini (1) , Merlin Paul (2) , Fabrice Barlesi (3) , Lionel Dany (2)

1 Service d'oncologie multidisciplinaire innovations thérapeutiques [Hôpital Nord - APHM]
2 LPS - Laboratoire de Psychologie Sociale
3 APHM - Assistance Publique - Hôpitaux de Marseille

Various studies have shown that the drafting of Advance Directives (AD) is relatively uncommon. This study was performed to explore cancer patients' attitudes toward advance directives, and their reasons for completing or not completing advance directive forms. The research included interdependent steps designed to gradually collect patients' agreement and comments concerning their participation in an AD study. A thematic content analysis was performed on patients' comments. A total of 147 patients spontaneously agreed to participate before the presentation of the specific theme (AD) of the study. A large majority of the sample reported having no knowledge about ADs. Of the patients who initially agreed to participate, two-thirds declined after the presentation of the theme of the study. The reasons of patients who declined to participate related to avoidance of the issue of death, a focus on present time perspective, or an ambivalence between the AD proposal and recovery plans. This study provides further evidence of the difficulties for patients to express their willingness to engage in AD discussions or research. The extent of the psychological issues experienced by patients and the level of avoidance they expressed raise many questions about the ethical issues and the spread of advance directives used in oncology settings.

Mots clés: living wills; advance directives; attitudes toward death; managed care; clinical ethics

Domaines: Psychologie

Patrice Cannone, Pascale Tomasini, Merlin Paul, Fabrice Barlesi, Lionel Dany. "I think it's a bit early for now": impact of psychological factors on drafting advance directives among cancer patients Running title: Advance directives for cancer patients. Journal of Psychosocial Oncology, 2019, 37 (1), pp.37-49. ⟨10.1080/07347332.2018.1541494⟩. ⟨hal-02527323⟩