ADVANCE DIRECTIVES AND CANCER: MEDICAL ONCOLOGY PRACTICE IN BRAZIL

Introduction: The prevalence of Advance Directives (AD) in cancer patients varies widely between countries, reaching 88% in the United States, 53% in Canada and 23% in Germany. Studies involving cancer patients since the 1990s have shown a very low preference (9% in the United States and 2% in Canada) among patients to discuss Advance Care Planning (ACP) and Advance Directives (AD) with their oncologists. Since 2012, the American (ASCO) and European (ESMO) societies of oncologists have been instructing clinical oncologists to approach their cancer patients to express care preferences as early as possible by discussing ACP and AD Objective: This study aims to evaluate the practice of clinical oncologists in Brazil on topics such as Palliative Care (CP), Advance Directives (AD) and Advance Care Planning (ACP) in cancer patients Methods: The study is observational, descriptive and cross-sectional, with clinical oncologists associated from Brazilian Society of Clinical Oncology. Clinical Oncologists were invited to participate in the research answering the questionnaire sent by e-mail through the Brazilian Society of Clinical Oncology (SBOC). The questionnaire was formulated by the authors from the object of the study which are the recommendations of ASCO and ESMO on Palliative Care, Advance Directives (AD) and Advance Care Planning (ACP) in patients diagnosed with cancer Results: 72 oncologists answered the questionnaire. 73% were under 45 years old, 56% had less than 10 years of experience in the speciality. 80.5% discuss diagnostic, prognostic and anti-cancer treatment in the first 8 weeks of care with patients. 70.4% offered palliative care for most of their patients with advanced disease but 57.2% do not discuss Advance Care Planning and 67% do not discuss Advance Directives with their patients. Regarding the term Advance Directives (AD) 67% of oncologists knew the term but its applicability was not incorporated into their practice, 8% were unfamiliar with the term and 22% knew the term AD and its applicability was incorporated into clinical practice contributing to patients in performing AD” Conclusion: In this trial, most oncologists do not define ACP and AD with patients. According to data in the literature, this study highlights the low participation of oncologists in end-of-life care discussions.