par Choucroun, Lisa
Président du jury Leys, Christophe
Promoteur Merckaert, Isabelle
Co-Promoteur Libert, Yves
Publication Non publié, 2025-05-09
Thèse de doctorat
Résumé : Guidelines recommend proactive communication between physicians and patients about advance care planning (ACP) to ensure that care aligns with patients' end-of-life (EOL) wishes. ACP involves two interconnected processes: communication about life-sustaining treatments (LSTs) and their subsequent documentation as a code status (CS) in medical records. Despite existing guidelines, a practical knowledge gap persists. The process of LST communication and documentation remains rare. When it does occur, it is often limited to the last days of life rather than being part of a proactive approach. This thesis addresses this gap through four chapters. First, a scoping review led to the development of a comprehensive ACP communication model. Second, two empirical studies examined LST communication and documentation. The first found that most patients had never discussed their LST preferences and were unwilling to do so, even when facing sentinel events that should have prompted these discussions. Unwillingness was predicted by medical, psychological, and communication-related factors identified in the ACP communication model. The second showed that while most patients receiving supportive care had their LST preferences documented, documentation often occurred late. Early documentation was associated with being married or partnered, having lung or gynecological/breast cancer, and minimal functional restrictions. Finally, a narrative review examined barriers to integrating early palliative care (EPC) teams to facilitate proactive LST documentation at patient, oncologist, and healthcare system levels. It also proposed multilevel strategies to address these barriers. This thesis clarifies multiple barriers to LST communication and documentation in advanced cancer care and identifies facilitators to improve these processes.

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