Department of Anesthesiology and Intensive Care, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Paris, France.
REQUIEM, Research/Reflexion on End of Life Support Quality in Everyday Medical Practice, Paris, France.
BMC Med Ethics. 2024 Nov 27;25(1):142. doi: 10.1186/s12910-024-01146-5.
The onset of hematological malignancies can lead to acute and critical situations. It can also result in adverse outcome despite the significant advancements made in their therapeutic management. In this context, advance care planning and, in particular, advance directives (AD) play an essential role. However, the use of AD in patients with malignant hematological conditions remains very rare.
MATERIAL & METHODS: The aim was to evaluate the perception of AD by hematologists. We conducted a national online survey in France. All hematologist working in a hospital setting and treating malignant hemopathies were solicited. The questionnaire covered five areas: personal perception of AD; assistance in writing AD; patient information about AD; use of ADs; and demographic data.
318 hematologists (33.7% of the whole population), working in 103 different centers across France participated in the study. 72.6% (n = 231) of the respondents believed that AD could be beneficial for patient's care. Only 32.7% talked about AD with their patients on a regular basis. The lack of utilization was correlated with the fear of creating anxiety for the patient (64.9%; n = 172) or for relatives (30.9%; n = 80), as well as the belief that AD were deemed inappropriate for their patients (57.8%; n = 145). 19.5% (n = 62) of responding hematologist offered their assistance to patients in writing AD. This proportion was higher in physicians who had previously worked in palliative care unit (35,6% vs. 16,8%, p = 0,0004).
The majority of the surveyed hematologist hold a positive opinion about AD. However, only a few discuss the matter with their patients. The fear of consequences for patients and relatives, particularly anxiety, remains the primary barrier to providing information about AD.
血液系统恶性肿瘤的发病可导致危急状况。尽管在其治疗管理方面取得了显著进展，但仍可能导致不良后果。在这种情况下，预先护理计划，特别是预先指示（AD）发挥着重要作用。然而，在恶性血液病患者中使用 AD 仍然非常罕见。
本研究旨在评估血液科医生对 AD 的认知。我们在法国进行了一项全国性的在线调查。邀请所有在医院工作并治疗恶性血液病的血液科医生参与。问卷涵盖五个方面：对 AD 的个人认知；协助撰写 AD；患者对 AD 的了解；AD 的使用；以及人口统计学数据。
共有 318 名血液科医生（占总人群的 33.7%）参与了这项研究，他们来自法国 103 个不同的中心。72.6%（n=231）的受访者认为 AD 可能对患者的护理有益。只有 32.7%的医生定期与患者讨论 AD。缺乏使用 AD 的情况与担心给患者（64.9%；n=172）或家属（30.9%；n=80）造成焦虑，以及认为 AD 不适合患者（57.8%；n=145）有关。19.5%（n=62）的调查血液科医生为患者提供撰写 AD 的协助。有过姑息治疗经验的医生提供协助的比例更高（35.6% vs. 16.8%，p=0.0004）。
大多数接受调查的血液科医生对 AD 持肯定态度。然而，只有少数医生与患者讨论此事。担心给患者和家属带来后果，特别是焦虑，仍然是提供 AD 信息的主要障碍。
