Clinical Epidemiology and Ageing

Promoting patients' rights at the end of life in a geriatric setting in France: The healthcare professionals' level of knowledge about surrogate decision-makers and advance directives.

Rwabihama J-P, Belmin J, Rakotoarisoa DRozier, Hagege M, Audureau E, Benzengli H, Ambime G, Rabus M-T, Bastuji-Garin S, Paillaud E, Oubaya N Patient Educ Couns. 2020;103(7):1390-1398.

OBJECTIVE: To assess levels of knowledge about patients' rights, surrogate decision-makers, and advance directives among healthcare professionals at three hospitals in France.

METHODS: A multicenter, cross-sectional study in three geriatric hospitals in the Paris area (France) in 2015. The participants' level of knowledge was assessed via an 18-item self-questionnaire on surrogate decision-makers, advance directives, and end-of-life decision-making. The characteristics associated with a good level of knowledge were assessed using logistic regression.

RESULTS: Among the 301 healthcare professionals (median ± standard deviation age: 40.4 ± 10.2 years; women: 73.4 %), only 15.0 % (95 % confidence interval (CI): [19.7-29.5]) correctly answered at least 75 % of the questions on patients' rights. Respectively 24.6 % [19.7-29.5], 36.5 % [31.1-42.0] and 37.5 % [32.0-43.0] had sufficient knowledge regarding "surrogate decision-maker", "advance directives", and "decision-making at the end of life". In a multivariable analysis, the only factor significantly associated with a good level of knowledge about end-of-life policy was employment in a university hospital, with a non-significant trend for status as a physician.

CONCLUSIONS: Our survey of staff working in geriatric care units highlighted the poor overall level of knowledge about healthcare surrogates and advance directives; the results suggest that additional training in these concepts is required.

PRACTICE IMPLICATIONS: Continuing education of healthcare professionals on advance directives and surrogate decision-maker should be promoted to ensure rights of elderly patients at the end of life.

DOI: 10.1016/j.pec.2020.01.020