Determinants of favorable or unfavorable opinion about euthanasia in a sample of French cancer patients receiving palliative care.

BACKGROUND: Opinion about euthanasia has been explored among the general population and recently in patients receiving palliative care. 96% of the French population declared themselves in favor of euthanasia while less of 50% of palliative care patients are. The aim of the present study was to explore and identify potential determinant factors associated with favorable or unfavorable opinion about euthanasia in a French population of cancer patients receiving palliative care. METHODS: We performed a cross-sectional study among patients in two palliative care units. Eligible patients were identified by the medical staff. Face-to-face interviews were performed by two investigators. Two groups were defined as favorable or unfavorable about euthanasia according to the answer on the specific question about patient opinion on euthanasia. A multivariate analysis including age, belief in God, chemotherapy and gender was built. RESULTS: Seventy-eight patients were interviewed. Median age was 60.5 years (range: 31-87.2). In univariate analysis, patients with a favorable opinion were most often under 60 years old (62 versus 38% unfavorable; p = 0.035), in couple (64 versus 35%; p = 0.032), didn't believe in God (72 versus 28% were non-believers; p < 0.001) and had more frequently an history of chemotherapy treatment (58 versus 42% received at least one cycle of chemotherapy; p = 0.005). In a multivariate analysis, age <  60 years, absence of belief in God and an antecedent of chemotherapy were independently associated with a favorable opinion about euthanasia (OR = 0.237 [0.076-0.746]; p = 0.014, OR = 0.143 [0.044-0.469]; p = 0.001, and OR = 10.418 [2.093-51.853]; p = 0.004, respectively). CONCLUSION: We report here determinants of opinion about euthanasia in palliative care cancer patients. Thus, young patients who do not believe in God and have a history of chemotherapy treatment are more likely to request the discontinuation or restriction of their treatment. A better understanding of these determinants is essential for the development of information and/or interventions tailored to the palliative context.

Use of artificial nutrition near the end of life: Results from a French national population-based study of hospitalized cancer patients.

BACKGROUND: The use of artificial nutrition, defined as a medical treatment that allows a non-oral mechanical feeding, for cancer patients with limited life expectancy is deemed nonbeneficial. High-quality evidence about the use of artificial nutrition near the end of life is lacking. This study aimed (a) to quantify the use of artificial nutrition near the end-of-life, and (b) to identify the factors associated with the use of artificial nutrition. METHODS: This was a retrospective cohort study of decedents based on data from the French national hospital database. The study population included adult cancer patients who died in hospitals in France between 2013 and 2016 and defined to be in a palliative condition. Use of artificial nutrition during the last 7 days before death was the primary endpoint. RESULTS: A total of 398 822 patients were included. The median duration of the last hospital stay was 10 (interquartile range, 4-21) days. The artificial nutrition was used for 11 723 (2.9%) during the last 7 days before death. Being a man, younger, having digestive cancers, metastasis, comorbidities, malnutrition, absence of dementia, and palliative care use were the main factors associated to the use of artificial nutrition. CONCLUSION: This study indicates that the use of artificial nutrition near the end of life is in keeping with current clinical guidelines. The identification of factors associated with the use of artificial nutrition, such as cancer localization, presence of comorbidities or specific symptoms, may help to better manage its use.

COVID-19 en Costa Rica: análisis longitudinal de las tasas de contagio y de fallecimiento desde el enfoque de la desigualdad social

Introducción: este artículo aborda la relación entre las tasas brutas de contagio y las tasas netas de fallecimiento por la COVID-19 -variables de estudio-, con indicadores socioeconómicos y de la salud -variables de contraste- en cuatro momentos de observación durante el primer año de la sindemia en Costa Rica. Los objetivos del trabajo fueron a) identificar los momentos de observación a partir de la cantidad de casos acumulados por semana epidemiológica; b) establecer la correlación estadística entre las tasas brutas de contagio y las variables de contraste; c) establecer la correlación estadística entre las tasas netas de fallecimientos y las variables de contraste; d) describir el desarrollo de las tasas de contagio y fallecimiento a nivel cantonal; e) caracterizar socioeconómicamente los cantones con valores muy altos en dichas tasas. Metodología: se desarrolló un estudio con enfoque cuantitativo mediante el método estadístico y la aplicación de pruebas de hipótesis de tipo bivariado, a saber, correlaciones Pearson y Spearman. Resultados: los principales resultados indicaron que el contagio está estrechamente vinculado, mayoritariamente, con factores socioeconómicos -densidad poblacional, índice de desarrollo social (IDS), índice de desarrollo humano (IDH) y tasas de delito contra el patrimonio-, mientras que los fallecimientos se asocian a factores biológicos como las tasas de enfermedades -hipertensión y respiratorias- Conclusiones: se demuestra la relación existente entre la enfermedad y las desigualdades sociales, es decir, cómo estas últimas se reproducen en el campo de la salud.

Introduction: This article addresses the relationship between the gross rates of transmission and the net death rates from COVID-19 -study variables-, with socioeconomic and health indicators -contrast variables- at four moments of observation during the first year of the syndemic in Costa Rica. The objectives of the research work are: a) identify the moments of observation based on the number of accumulated cases per epidemiological week; b) establish the statistical correlation between the crude rates of transmission and the contrast variables; c) establish the statistical correlation between the net death rates and the contrast variables; d) describe the development of transmission and death rates at the cantonal level, and e) socioeconomically characterize the cantons with very high values in those rates. Methods: A study with a quantitative approach is developed through the statistical method and the application of hypothesis tests at a bivariate level, namely, Pearson and Spearman correlations. Results: The main results indicate that transmission is closely related, mostly, to socioeconomic factors -population density; Social Development Index (IDS); Human Development Index (HDI) and crime rates against property-, while deaths they are related to biological factors such as the rates of diseases -hypertension and respiratory-. Conclusion: The study demonstrates the relationship between disease and social inequalities, that is, how social inequality is reproduced in the field of health.

End-of-Life Practices in France under the Claeys-Leonetti Law: Report of Three Cases in the Oncology Unit.

On February 2, 2016, the French government enacted the Claeys-Leonetti law introducing the right to deep and continuous sedation and forbade euthanasia for end-of-life patients. This article reports the first descriptions of this kind of intervention at the final stage of life of 3 patients and highlights the need of patient-centered goals and the importance of close collaboration between the patient, family, and medical and paramedical team to achieve a higher quality of final palliative care.