Does Any Transverse and Invariable Barrier for Writing and Carrying Out an Advance Directive Exist?

Cyril Hazif Thomas, Victor Le Guen, Claire Montloin, Gabriel Perraud, Bernard Le Floch, Morgane Guillou, Jean Yves Le Reste, Patrice Nabbe

Keywords: Advance directive, uncertainty, conflict anxiety

Background:
Advance directives represent a strong societal debate, and improving its completion rate a subject of interest. After the identification of barriers from specific populations accomplished by the ER 7479 SPURBO, a question occurs: does any transverse and invariant barrier for writing and carrying out advance directives exist?

Research questions:

Method:
To resolve the question, a pragmatic approach inspired by the Grounded Theory had been chosen. It combined a set of systematic reviews of the literature and qualitative studies previously done by the EA-7479-SPURBO used as datas. A conceptual model, resulting from the synthesis of all this research, was produced to answer the research question.

Results:
Eleven open codes, three sub themes had been spotted, gathered under an invariant and transversal theme: the conflict anxiety, which represented a transversal barrier as the research question asked.
As a way to understand the mechanism of this barrier, a conceptual model was proposed. Eleven accessible and empirical elements acted in a synergic way to irrigate three theoretical concepts (Altered confidence, advance directive’s viability, leading to a change in behaviour) improving uncertainty. By doing so, the three concepts gave access to the core of the conceptual model, the conflict anxiety.

Conclusions:
By submitting this, it allowed a broader vision of the advance directive’s concept and may allow a better comprehension of that barrier standing against the application of advance directive, and so for every person involved.

Points for discussion:
Are you confronted with advance directives in your respective countries?

Do you think that this question should be harmonized in europe? and do you think it is possible?