Swiss physicians' perspectives on advance directives in elective cardiovascular surgery

When patients are incompetent, advance directives (AD) can help physicians take crucial medical decisions. However, prevalence remains low. The objective was to investigate physicians' perspectives and attitudes towards AD in order to determine potential targets for improvement.

Observational study by self-administered questionnaires to general practitioners and specialists potentially involved in the care of patients scheduled for major cardiovascular surgery in a Swiss canton.

One-hundred and sixty-four 164 (40%) questionnaires were completed. Men: 116 (71%). Specialties: Internists: 73 (45%); General Practitioners: 50 (31%); Intensivists: 22 (13%); Cardiologists: 18 (12%). Eighty-five percent (138/162) physicians thought that AD were useful and 124/161 (77%) were ready to help patients write AD (to allow them to decide on their fate [115/124 {93%}] and to increase their ease in expressing their wishes [108/124 {87%}]). Men and cardiologists were least likely to do so. Factors associated with lower interest in promoting AD were not logistical but personal such as "the topic can induce fear (21/34 [62%]) or unease (16/34 [47%]), and lack of knowhow (15/34 [44])". 22/160 (14%) physicians had never heard about AD, especially men.

Not all physicians knew the concept of AD. The majority thought that AD were useful and would help patients write them, in order to respect their autonomy. Personal-related factors such as feelings of inducing fear or harm patients were more important than logistic factors in impeding the promotion of AD. Emphasizing AD during medical school might present a potential target to increase AD prevalence, particularly in the preoperative setting.