Legalisation of euthanasia and assisted suicide: advanced cancer patient opinions - cross-sectional multicentre study.

OBJECTIVES: The French government voted a new law in February 2016 called the Claeys-Leonetti Law, which established the right to deep and continuous sedation, confirmed the ban on euthanasia and ruled out physician-assisted suicide. The aim of this work was to gather the opinion of patients on continuous sedation and the legalisation of medical assistance in dying and to explore determinants associated with favourable and unfavourable opinions. METHODS: This was a French national prospective multicentre study between 2016 and 2020. RESULTS: 331 patients with incurable cancer suffering from locally advanced or metastatic cancer in 14 palliative care units were interviewed. 48.6% of participants expressed a favourable opinion about physician-assisted suicide and 27.2% an unfavourable opinion about its legalisation. Regarding euthanasia, 52% of patients were in favour of its legalisation. In univariate analysis, the only factor determining opinion was belief in God. CONCLUSIONS: While most healthy French people are in favour of legalising euthanasia, only half of palliative care patients expressed this opinion. Medical palliative care specialists were largely opposed to euthanasia. The only determining factor identified was a cultural factor that was independent of the other studied variables. This common factor was found in other studies conducted on cohorts from other countries. This study contributes to the knowledge and thinking about the impact of patients' personal beliefs and values regarding their opinions about euthanasia and assisted suicide. TRIAL REGISTRATION NUMBER: NCT03664856.

[The advanced practice nurse in a supportive care department: The missing link?] / L'infirmière en pratique avancée au sein d'un service de soins de support : le chainon manquant ?

INTRODUCTION: Cancer has become a chronic disease thanks to therapeutic evolutions and justifies the early integration of supportive care in the management. The Advanced Practice Nurse (APN) was created to respond to the increase in the number of patients followed in the long term. The objective of this study is to identify the place and expected missions of an APN within a multidisciplinary supportive care team. MATERIAL AND METHOD: A qualitative study by semi-directed interview using a previously developed interview grid was carried out with 14 health professionals (doctors, nurses and health managers) working in a supportive care service in three Cancer Centres. RESULTS: The role expected by the participants is based on the optimisation of patients' follow-up, the integration of supportive care into the care pathway, the improvement of the relationship with the town, and the development of nursing leadership in the establishment. At the same time, the potential arrival of an APN as a change agent in a supportive care service is a source of fears. DISCUSSION: The APN seems to be a real link in the institutional organisations facilitating the link between the professionals of the institution and with the professionals of the territory. The identification of the origins of the fears expressed should enable work to be done to facilitate the integration of the APN into specific support care services, particularly for patients in palliative situations.

[End-of-life care pathways of patients followed in palliative care in Strasbourg: A retrospective study]. / Parcours de soins en fin de vie des patients suivis en soins palliatifs à Strasbourg : étude rétrospective.

OBJECTIVES: The goal of palliative care is to relieve suffering and provide the best possible quality of life for patients and their families. We looked for individual factors related to a poor-quality end-of-life pathway in patients followed in palliative care. METHODS: We included all the patients followed in palliative care in Strasbourg deceased from October to December of 2020. We retrospectively collected data about these patients, their first contact with palliative care, their care pathway, and their death. Multivariate analysis was undertaken. RESULTS: In total, 116 patients were included. Seventy-nine of them had cancer. At the end of life, people living in an institution were less likely to be admitted to the emergency department (OR=0.06), as were non-communicative patients (OR=0.08). Patients expressing a wish to die at home were less likely to be admitted to and die in an intensive care unit (OR=0.1). Isolated patients and non-communicative patients appeared protected from aggressive treatment (chemotherapy/immunotherapy, dialysis, orotracheal intubation, cardiopulmonary resuscitation) during the last month of life (OR=0.1, OR=0.05). DISCUSSION: Our study suggests a profile of patients less exposed to invasive or unreasonable care at the end of life. It leads us to pay particular attention to young subjects, with family, living at home. In our population followed in palliative care, exposure to aggressive care at the end of life appeared to be very low compared to that observed in similar studies with other populations.

Critically ill cancer patient's resuscitation: a Belgian/French societies' consensus conference.

To respond to the legitimate questions raised by the application of invasive methods of monitoring and life-support techniques in cancer patients admitted in the ICU, the European Lung Cancer Working Party and the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique, set up a consensus conference. The methodology involved a systematic literature review, experts' opinion and a final consensus conference about nine predefined questions1. Which triage criteria, in terms of complications and considering the underlying neoplastic disease and possible therapeutic limitations, should be used to guide admission of cancer patient to intensive care units?2. Which ventilatory support [High Flow Oxygenation, Non-invasive Ventilation (NIV), Invasive Mechanical Ventilation (IMV), Extra-Corporeal Membrane Oxygenation (ECMO)] should be used, for which complications and in which environment?3. Which support should be used for extra-renal purification, in which conditions and environment?4. Which haemodynamic support should be used, for which complications, and in which environment?5. Which benefit of cardiopulmonary resuscitation in cancer patients and for which complications?6. Which intensive monitoring in the context of oncologic treatment (surgery, anti-cancer treatment …)?7. What specific considerations should be taken into account in the intensive care unit?8. Based on which criteria, in terms of benefit and complications and taking into account the neoplastic disease, patients hospitalized in an intensive care unit (or equivalent) should receive cellular elements derived from the blood (red blood cells, white blood cells and platelets)?9. Which training is required for critical care doctors in charge of cancer patients?

Difficulties in providing palliative care in identified palliative care beds: An exploratory survey.

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.