Advance Directives in Oncology and Haematology: A Long Way to Go—A Narrative Review

Kevin Serey,Adrien Pollina-Bachellerie,Amélie Cambriel,Jean-Pierre Lotz,François Philippart

doi:10.3390/jcm11051195

Abstract

Patients living with cancer often experience serious adverse events due to their condition or its treatments. Those events may lead to a critical care unit admission or even result in death. One of the most important but challenging parts of care is to build a care plan according to the patient’s wishes, meeting their goals and values. Advance directives (ADs) allow everyone to give their preferences in advance regarding life sustaining treatments, continuation, and withdrawal or withholding of treatments in case one is not able to speak their mind anymore. While the absence of ADs is associated with a greater probability of receiving unwanted intensive care around the end of their life, their existence correlates with the respect of the patient’s desires and their greater satisfaction. Although progress has been made to promote ADs’ completion, they are still scarcely used among cancer patients in many countries. Several limitations to their acceptance and use can be detected. Efforts should be made to provide tailored solutions for the identified hindrances. This narrative review aims to depict the situation of ADs in the oncology context, and to highlight the future areas of improvement.

Highlights

Introduction published maps and institutional affilCancer is becoming more frequent as the population ages
The prognosis of cancer patients requiring intensive care unit (ICU) has improved during the last decades [8], their mortality is very high [9,10], and residual morbidity is common among survivors [4,11]
The aim of this review is to look at factors associated with the presence or absence of Advance Directives

Summary

Introduction

Cancer is becoming more frequent as the population ages. Great therapeutics improvements have been made, cancer remains a very severe condition. Both cancer and its treatments are responsible for patients’ weakening condition [4,5], thereby sowing the seeds for acute illnesses and potential need for intensive care [6,7]. The major issue in such context is to define the potential relevance of critical care. The prognosis of cancer patients requiring intensive care unit (ICU) has improved during the last decades [8], their mortality is very high [9,10], and residual morbidity is common among survivors [4,11]

Objectives

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Discussion

Conclusion