Palliative care in day-hospital for advanced cancer patients: a study protocol for a multicentre randomized controlled trial.

BACKGROUND: Team-based and timely integrated palliative care is a gold standard of care in oncology, but issues concerning its optimal organization remain. Palliative Care in Day-Hospital (PCDH) could be one of the most efficient service model of palliative care to deliver interdisciplinary and multidimensional care addressing the complex supportive care needs of patients with advanced cancer. We hypothesize that, compared to conventional outpatient palliative care, PCDH allows the clinical benefits of palliative care to be enhanced. METHODS/DESIGN: This study is a multicentre parallel group trial with stratified randomization. Patient management in PCDH will be compared to conventional outpatient palliative care. The inclusion criteria are advanced cancer patients referred to a palliative care team with an estimated life expectancy of more than 2 months and less than 1 year. The primary endpoint is health-related quality of life with deterioration-free survival based on the EORTC QLQ-C30 questionnaire. The secondary objectives are the following: increase in patient satisfaction with care using the EORTC PATSAT-C33 and OUT-PATSAT7 questionnaires, better understanding of the prognosis using the PTPQ questionnaire and advance care planning; decrease in the need for supportive care among relatives using the SCNS-P&C-F questionnaire, and reduction in end-of-life care aggressiveness. Patients will complete one to five questionnaires on a tablet before each monthly visit over 6 months and will be followed for 1 year. A qualitative study will take place, aiming to understand the specificity of palliative care management in PCDH. Cost-effectiveness, cost-utility and, an additional economic evaluation based on capability approach will be conducted from a societal point of view. DISCUSSION: The first strength of this study is that it combines the main relevant outcomes assessing integrated palliative care; patient quality of life and satisfaction; discussion of the prognosis and advance care planning, family well-being and end-of-life care aggressiveness. The second strength of the study is that it is a mixed-method study associating a qualitative analysis of the specificity of PCDH organization, with a medical-economic study to analyse the cost of care. TRIAL REGISTRATION: Name of the registry: IDRCB 2019-A03116-51 Trial registration number: NCT04604873 Date of registration: October 27, 2020 URL of trial registry record.

Éducation du patient et « rapport à soi ¼ après un cancer du sein.

OBJECTIVE AND METHODS: Prevention programs recommend regular physical activity and a balanced diet after cancer treatment. Based on a qualitative research using a medical philosophy approach, this article aims to better understand people’s experience after an educational therapy program. At the end of treatment for localized breast cancer, interviews were conducted to analyze the experience of 23 women aged 30 to 84 years, half of whom had followed such a program. RESULTS: Women’s narratives differed according to their participation in the program. Those who did not attend had no specific physical activity or diet. They made no link between lifestyle and cancer. Conversely, women who attented the program were aware of prevention recommendations. They acknowledged the link between lifestyle and cancer. Two groups stand out.The first group believes in this link. Among these women, a first sub-group was able to change their lifestyle easily. They developed a “performing” self-relationship. In the other subgroup, the practice is difficult and the relationship is marked by “self-responsability” and even guilt.The second group does not believe in the link. Practice may or may not follow the recommendations. It depends on people’s preferences. The self-relationship is “self-expression”. CONCLUSION: Patient education after cancer can lead to both positive and negative experiences. We need to analyze this in relation to the programs’ characteristics.

Breast Cancer Survivors' Supportive Care Needs, Posttraumatic Growth and Satisfaction with Doctors' Interpersonal Skills in Relation to Physical Activity 8 Months after the End of Treatment: A Prospective Exploratory Study.

OBJECTIVE: We assessed whether breast cancer survivors' (BCSs) supportive care needs, posttraumatic growth (positive psychological changes) and satisfaction with doctors' interpersonal skills could be related to physical activity (PA). METHODS: A total of 426 BCSs were approached during the last week of treatment. Eight months later, 278 (65%) provided information on their PA levels. Ordinal logistic multiple regressions were performed. RESULTS: PA levels included no PA (n = 68), some PA (n = 83), high PA levels more than twice or more than 2 h per week (n = 127). The multivariate model significantly explained 13% of PA variance (p = 0.001). An increase in posttraumatic growth total scores (proportional OR = 1.310; p < 0.05) and a decrease in physical and daily living supportive care needs subscale scores (proportional OR = 0.980; p < 0.001) and in satisfaction with doctors' interpersonal skill scores (proportional OR = 0.898; p < 0.05) were significantly associated with an increase in the likelihood of performing higher levels of PA. A lower educational level was associated with a decrease in the likelihood of performing PA. CONCLUSION: The prevalence of PA in BCSs should be improved. Positive psychological changes after a breast cancer experience might contribute to performing PA. Encouraging PA needs to be accompanied by the alleviation of physical symptoms.

[Improved understanding of the experience of physical activity after a cancer from a philosophy of health perspective]. / Mieux comprendre l'expérience de l'activité physique après un cancer grâce à la philosophie de la santé.

We found that this programme had a positive impact on physical activity and four different types of profiles regarding the role of physical activity in the woman's life and personal values were identified. These results support the need for a better understanding by health promotion professionals of women's life values in order to more effectively help them after breast cancer treatment. .

Adapted physical activity interventions and motivational levers: What benefits for type 2 diabetics? A systematic review.

Background and Aims: Scientific research continues to advance and improve the medical management of type 2 diabetes. However, the importance of lifestyle management remains invaluable in treatment and tertiary prevention of this disease. Day-to-day sedentariness is the fourth most important risk factor for mortality in France. Numerous studies have demonstrated that physical activity is beneficial to people with type 2 diabetes and various recommendations have been made to encourage it. However, it is universally agreed that interventions that promote physical activity, while they may enhance its practice in the short term, do not impact on it over longer periods. It therefore seems essential to focus interventions on an individual's capacity to persist with physical activity in the long term. By looking at the literature, the aim of this review is to synthesize group and supervised physical activity interventions for people with type 2 diabetes using variables based on the following levers: motivation and self-efficacy. Methods: The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) methodology examined studies in English or French that are registered in the PubMed, PsycINFO, and SportDiscus databases and were published between 2005 and 2023, according to the following keywords: Motivation OR self-efficacy AND physical activity AND type 2 diabetes AND intervention. Results and Conclusion: Seven studies out of 1207 were included. Despite the pertinence of the concepts of motivation and self-efficacy and their complementarity in physical activity management programs, few studies have yet proposed a combined intervention for people with type 2 diabetes.

Effectiveness of a community-based multicomponent lifestyle intervention (the ADA programme) to improve the quality of life of French breast cancer survivors: protocol for a pragmatic cluster randomised trial and embedded qualitative study.

INTRODUCTION: Breast cancer survivors (BCSs) are often faced with multiple mental and physical sequelae and are at increased risk of emotional distress, degraded health-related quality of life (HRQoL), chronic pain and fatigue.Physical activity is strongly associated with improved HRQoL and survival rates; however, adherence rates to recommendations for a healthy lifestyle are seldom satisfactory among BCSs. Also, few studies have examined the effectiveness of multicomponent and personalised interventions that integrate physical activity and motivational techniques to improve the HRQoL of BCS. METHOD AND ANALYSIS: "Activité physique adaptée Doublée d'un Accompagnement d'après cancer" (ADA) is an integrated programme of physical activity enriched with a dietary and supportive care approach targeting BCS in the early post-treatment phase. The effectiveness of the ADA intervention will be evaluated using a cluster randomised controlled trial design with two arms (ADA programme vs usual care; 1:1 ratio).The ADA intervention aims to recruit 160 participants and will be implemented by Siel Bleu, a non-profit association specialised in health prevention via adapted physical activity. Measurements will be performed at baseline, 3, 6 and 12 months after the start of the intervention. The primary outcome will be participants' HRQoL, at 12 months measured by the Functional Assessment of Chronic Illness Therapy-Fatigue global score. Secondary outcome will include participants' physical, social, emotional and functional well-being. The effect of the intervention on physical activity level, motivation for physical activity, relation to food and self-efficacy will also be evaluated. ETHICS AND DISSEMINATION: The study was approved by the 'CPP Paris XI' Institutional Review Board on 5 May 2022 (Ref no.: 21.04512.000048-22004). The study's findings will be shared through various channels, including academic publications, simplified reports for wider audiences and active engagement with medical and institutional organisations as well as patients' associations. TRIAL REGISTRATION NUMBER: NCT05658341.

[Benchmarks for interdisciplinary health and social sciences research: contributions of a research seminar]. / Jalons pour une recherche interdisciplinaire en santé et en sciences humaines et sociales: apports d'un séminaire de recherche.

This article proposes a reflection on an interdisciplinary seminar, initiated by philosophy and sociology researchers and public health professionals. The objective of this seminar was to explore the mechanisms involved in setting up and conducting interdisciplinary research, by investigating the practical modalities of articulating health and human and social sciences research in order to more clearly understand the conditions, tensions and contributions of collaborative research. These questions were discussed on the basis of detailed analysis of four recent or current research projects. Case studies identified four typical epistemological or methodological issues faced by researchers in the fields of health and human and social sciences: institutional conditions and their effects on research; deconstruction of the object; the researcher's commitment in his/her field; the articulation of research methods. Three prerequisites for interdisciplinary research in social and human sciences and in health were identified: mutual questioning of research positions and fields of study; awareness of the tensions related to institutional positions and disciplinary affiliation; joint elaboration and exchanges between various types of knowledge to ensure an interdisciplinary approach throughout all of the research process.

[Experience of care and daily life during national sanitary confinement in patients followed and treated in Cancer Control Centers: The BaroCov Inquiry]. / Expérience des soins et de la vie quotidienne pendant le confinement sanitaire national chez des patients suivis et traités en centre de lutte contre le cancer : l'enquête BaroCov.

Confinement within the framework of Covid 19 required organizations in cancer centers, in particular with postponing certain treatments. We interviewed 6080 patients who had a scheduled appointment during this period. 2478 patients gave their opinion regarding access and organization of care, teleconsultation, their concerns and their reasons for satisfaction. While 83 % of them say they are satisfied with the organization of care, 25 % of respondents say they have given up care that they consider essential in 1/3 of cases. The concern related to the follow-up of the cancerous disease takes precedence over that of being infected with the Sars-cov-2 virus, unlike the general population, and relationships with their loved ones are spontaneously cited as a reason for satisfaction. This method captures the experience of patients, despite certain limitations. Such an approach could be used to set up a specific system during normal periods.

[Adapting to the SARS-CoV2 pandemic: Experience of the Curie Institute]. / S'adapter face à la pandémie SARS-CoV2 : l'expérience de l'Institut Curie.

The Curie Institute exclusively cares for cancer patients, who were considered particularly "vulnerable" from the start of the SARS-CoV 2 pandemic. This pandemic, which took the medical world by surprise, suddenly required the Institute's hospital to undergo rapid and multimodal restructuring, while having an impact on everyone to varying degrees. We will examine here how this hospital has coped, with the concern for a new benefit-risk balance, in times of greater medical uncertainty and scarcity of certain resources, for these "vulnerable" patients but also for their relatives and staff. We will highlight by theme the positive aspects and difficulties encountered, and then what could be useful for other hospitals as the pandemic is ongoing.

Nutrition and physical activity professional education in gastrointestinal oncology: a national multidisciplinary survey.

OBJECTIVES: Sarcopenia, present in more than 50% of digestive oncology patients, has a negative impact on clinical outcomes. Nutrition and adapted physical activity are two major interventions for the management of sarcopenia. However, young hepato-gastroenterologists, oncologists and surgeons in France have limited awareness on these topics. We aimed to evaluate the need for training programmes of physicians (residents and senior doctors) involved in digestive oncology on nutrition and adapted physical activity. METHODS: A 42-question survey was developed, by a working group of clinicians, dieticians and adapted physical activity teachers, to assess five areas related to demographics of respondents, nutrition practices, nutrition training, adapted physical activity practices and adapted physical activity training. The national survey was undertaken between April and July of 2019. RESULTS: 230 physicians participated in the survey; 34% were hepato-gastroenterologists, 31% were oncologists, 23% were surgeons and 40% were residents. Sixty-one per cent of participants had received training in nutrition and only 21% in adapted physical activity. Ninety per cent of the physicians expressed their desire for more effective training on these two topics. Disparities in clinical practices were observed between hepato-gastroenterologists, oncologists and surgeons. CONCLUSIONS: More initial and continuing training on nutrition and adapted physical activity is needed for French physicians in the current digestive oncology clinical practice.

Chronic palliative care: specific practices for Alzheimer's disease sufferers.

INTRODUCTION: In France, the government's plan to combat Alzheimer's disease takes into consideration mostly the beginnings of the disease; it does not deal with the sufferers' end of life. For this pathology, the very idea of a palliative care phase and its definition are not straightforward. METHOD: The object of this qualitative study was to clarify this idea through a series of interviews with 44 professionals. RESULTS: The study describes three successive phases in the disease trajectory, revealed by changes in the logic of care: the stimulation phase, the chronic palliative care phase, and the terminal palliative phase. CONCLUSION: Alzheimer's disease has a specific phase of chronic palliative care. It presents, for professionals, several types of problems related to communication, pain, and feeding.

Influence of nurse's involvement on practices during end-of-life decisions within stroke units.

OBJECTIVES: Decision-making processes concerning end-of-life decisions are not well understood for patients admitted into stroke units with severe stroke. To assess the influence of nurses on the medical perspectives and approaches that lead to withholding and/or withdrawing treatments related to end-of-life (EOL) decisions. PATIENTS AND METHODS: This secondary analysis nested within the TELOS French national survey was based on a physicians' self-report questionnaire and on a I-Score which was linked to nurses' involvement. Physician's responses were evaluated to assess the potential influence of nurse's involvement on physician's choices during an end-of-life decision. RESULTS: Among the 120 questionnaires analyzed, end-of-life decisions were more often made during a round-table discussion (58% vs. 35%, p = 0.004) when physicians declare to involve nurses in the decision process. Neurologists involved with nurses in decision making were more likely to withhold a treatment (98% vs. 88%, p = 0.04), to withdraw artificial feeding and hydration (59% vs. 39%, p = 0.04), and more frequently prescribed analgesics and hypnotics at a potentially lethal dose (70% vs. 48%, p = 0.03). CONCLUSION: The involvement of nurses during end-of-life decisions for patients with acute stroke in stroke units seemed to influence neurologists' intensivist practices and behaviors. Nurses supported the physicians' decisions related to forgoing life sustaining treatment for patients with acute stroke and may positively impact on the family's choice to participate in end-of-life decisions.

[An exploratory qualitative study on decisions to reduce current active therapeutic staff working in emergency care and the decisions-making of health care teams in emergency room treatment.]. / Les décisions de limitation de thérapeutiques actives aux urgences, une étude qualitative exploratoire.

During the last decade, end of life care has become a public health problem in France. The objective of this study is to give an account of the limitations of decisions made by emergency room staff. An analysis was conducted to better understand practices and the logical decision-making processes by two emergency room teams. Twenty-three interviews (22 individual interviews and one focus group) were conducted with doctors, nurses, nursing auxiliaries and members of families. Based on the recommendations of the French society of emergency medicine, we examine the place of the doctor, the healthcare team, the family and the patient in these decisions. The study reveals that, beyond general principles approved by health professionals, today it is the practical implementation of these recommendations that is necessary in order to for a change in practice.

[Extending the palliative approach across the French health system]. / Diffuser la démarche palliative dans le système de santé français.

The care provision for people at the end of life requires a palliative care approach to be extended across the whole healthcare system. Access to palliative care for everyone requires training for professionals, support for specialised structures and teams as well as clear political will.

[The main missions of the National Palliative Care Resource Centre]. / Diffusion de la démarche palliative, une mission phare du Centre national de ressources soin palliatif.

The French National Palliative Care Resource Centre (CNDR) provides people impacted by the end of life, death and bereavement with a range of constantly evolving services. Spreading the palliative approach in order to enable everyone to benefit from it and appropriate it constitutes the main mission of the CNDR.