Social inequalities in cervical cancer screening: a discrete choice experiment among French general practitioners and gynaecologists.

BACKGROUND: Cervical cancer screening is effective in reducing mortality due to uterine cervical cancer (UCC). However, inequalities in participation in UCC screening exist, especially according to age and social status. Considering the current situation in France regarding the ongoing organized UCC screening campaign, we aimed to assess general practitioners' (GPs) and gynaecologists' preferences for actions designed to reduce screening inequalities. METHODS: French physicians' preferences to UCC screening modalities was assessed using a discrete choice experiment. A national cross-sectional questionnaire was sent between September and October 2014 to 500 randomly selected physicians, and numerically to all targeted physicians working in the French region Midi-Pyrénées. Practitioners were offered 11 binary choices of organized screening scenarios in order to reduce inequalities in UCC screening participation. Each scenario was based on five attributes corresponding to five ways to enhance participation in UCC screening while reducing screening inequalities. RESULTS: Among the 123 respondents included, practitioners voted for additional interventions targeting non-screened women overall (p <  0.05), including centralized invitations sent from a central authority and involving the mentioned attending physician, or providing attending physicians with the lists of unscreened women among their patients. However, they rejected the specific targeting of women over 50 years old (p <  0.01) or living in deprived areas (p <  0.05). Only GPs were in favour of allowing nurses to perform Pap smears, but both GPs and gynaecologists rejected self-collected oncogenic papillomavirus testing. CONCLUSIONS: French practitioners tended to value the traditional principle of universalism. As well as rejecting self-collected oncogenic papillomavirus testing, their reluctance to support the principle of proportionate universalism relying on additional interventions addressing differences in socioeconomic status needs further evaluation. As these two concepts have already been recommended as secondary development leads for the French national organized screening campaign currently being implemented, the adherence of practitioners and the adaptation of these concepts are necessary conditions for reducing inequalities in health care.

French Therapeutic Education Programme Aimed at Improving the Quality of Life of Laryngectomised Patients and their Close Relations: the Three Stages (Observational and Interventional Randomised) of the Study "PETAL".

The therapeutic education of patients and their close relations is, as yet, poorly developed in France in the field of oncology. Total laryngectomy is a mutilating surgical procedure having a major impact on the patient's life, due to its physical and functional sequelae. Its psychosocial consequences are also important and alter the quality of life of patients and their close relations. Currently, care for laryngectomised patients consists essentially in informing and educating them on some technical procedures during hospital admission. The intervention of a speech therapist, often serves as the link between the patient and the hospital care team. These healthcare modalities often insufficiently account for the social, environmental and personal factors that interact in health-related problems. This report presents the therapeutic education programme protocol "PETAL" for laryngectomised patients and their close relations to improve their quality of life. The trial will be conducted over three phases: (1) the "pilot" phase aims at developing knowledge on the consequences of laryngectomy on the quality of life of patients and their close relations and developed a pluridisciplinary therapeutic education program, (2) the prospective intervention "replication" phase aims at evaluating the programme's transferability in three centres and (3) the cluster-randomised multicentric comparative intervention phase, will assess the benefits of the developed programme. Phase I identified nine themes of workshops related to therapeutic education, training and coordination of care. The developed programme should reinforce town-hospital links to improve help, follow-up and support for patients and their close relations.

Young couples' experiences of breast cancer during hormone therapy: an interpretative phenomenological dyadic analysis.

BACKGROUND: Young women are confronted with the same consequences of cancer as older women are. In addition, they face problems specifically related to their age, such as their children's education and their family responsibilities, marital relationships, and career issues. OBJECTIVE: The objective was to identify the functioning profiles of young couples confronted with hormone therapy. METHODS: This study was both qualitative and dyadic. Interviews with 11 couples revealed 5 themes. RESULTS: Initially, the partners reported increased intimacy and mutual support; however, during hormone therapy, a divergence developed between the patients and their partners. The partners wished for the couple to resume a normal life. The patients' loved ones, also helpful in the beginning, were tempted to promote this resumption of normalcy, with the risk that the patients' suffering would no longer be acknowledged. The risk of cancer recurrence appeared to immobilize the patients, who were unable to adopt a long-term perspective. Finally, the experience of the disease led the participants to reorganize their priorities and promoted self-centering. CONCLUSIONS: Breast cancer affects both the patient and her loved ones. Future research should focus on qualitative extensions to other stages of cancer treatment and quantitative studies to measure the phenomena revealed in the current work. IMPLICATIONS FOR PRACTICE: Cancer and its treatment have impacts on the patient and her marriage; therefore, the focus for the clinical care should be on the couple rather than just the patient. Additionally, our findings suggest new areas of psychological dyadic counseling for cancer patients and their partners.