Dyl, Céline <br/><br/>
Is it possible to co-create “patient-physician” advance directives in a palliative care unit? 

 -  2019.<br/>							 
<br/><br/> 46 
<br/><br/> For patients admitted to palliative care units (PCUs), advance directives (ADs) could be a tool for determining their wishes and ensuring that their autonomy is respected. However, ADs are rarely written or, if they are, they are often not very useful. The aim of this study is to assess the feasibility of co-creating ADs in PCUs. Our qualitative action research project was carried out over two months in the PCU of the University Hospital of Bordeaux. Eligible patients were offered the opportunity to co-create ADs with the help of a physician during a semi-directed interview about their end-of-life care and support. A content analysis of the interviews was carried out, followed by an evaluation of the process using a satisfaction questionnaire. Of the 28 patients hospitalized in the PCU over this period, 12 were eligible to participate in the study. Seven patients accepted, but the condition of five of them quickly deteriorated, meaning that only two interviews were eventually carried out. The difficulties we identified when it came to making ADs were choosing the appropriate time to initiate the process and the need to adapt to both the patient and the situation. Nevertheless, this co-creation seemed to allow a better contextualization of ADs in the sense of a global approach. It was difficult to write ADs because of the advanced stage of disease in the patients involved. We found that it is necessary to obtain the information needed for ADs earlier, for example during the phase when the patient is receiving specific treatments. In addition, the co-creation of ADs could improve their relevance and usefulness.