Représentations et pratiques du jeûne et des régimes restrictifs pendant la chimiothérapie.

Introduction : The idea of therapeutic fasting with healing virtues is circulating among cancer patients. Our study aims to improve knowledge of this practice, which is contraindicated in France during chemotherapy, and to establish recommendations to facilitate exchanges between doctors and patients.Methods : Chemotherapy patients completed a self-questionnaire on diet, therapeutic fasting and alternative medicine. A subsample of patients intending to follow dietary restrictions were interviewed.Results : Among the 133 participants, more than half had changed their diet and/or had heard of therapeutic fasting. Twenty-one patients intended to fast or have dietary restrictions during chemotherapy. These were mainly women, with an average age of 56 years, being treated for breast cancer, using alternative medications. They had little interaction with the health care team but would have liked to have had some with their oncologist. Nine patients were interviewed. They had tested short fasting and/or a ketogenic diet to improve treatment efficacy, reduce side effects and/or gain more control over their management. They did not dare to talk about it with the oncologist but regretted their silence. They are often advised by naturopaths and have tested homeopathy to accompany their treatment.Conclusions : Patients explain that they want to put all the odds in their favor. They would like the medical profession to offer times for discussion on fasting, silence being perceived as potentially harmful.

Current perceptions of cancer nurses in France about their role and the evolution of nursing practices: Findings and perspectives.

BACKGROUND: Florence Nightingale lamented that nurses were seen as merely obedient and devoted. Our two previous oncology studies demonstrated the continuum of strictly curative care and paternalistic care practices among healthcare professionals. At a time when France has just formalized the nursing sciences, this article seeks to shed light on the specifics of the nursing role in oncology and the evolution of standard nursing practices in a rapidly changing environment. METHODS: We performed a secondary qualitative analysis, on the same dataset, focusing only on the nursing population (n = 20), to answer a question not excavated through the two previous studies. The COREQ guidelines were used to ensure the rigorous reporting of this study. FINDINGS: The data analysis show that the inherent role and application of medical directives characterise the profession of nursing in oncology. The former is essentially an intermediary role, whereby the nurse directs the patient to a professional specialist for a problem identified through clinical nursing expertise. The latter is expressed through the application of various medical instructions. The results highlight a minor evolution in nursing practices, despite an evolving environment. Oncology nurses do not seem to authorise themselves to become agents of change. CONCLUSION: Various reforms and studies of the nursing profession, as well as public funding of programmes dedicated to nursing research were designed to facilitate the integration of Evidence Based Practice to encourage the autonomy of nurses in their practices. Education in research is fundamental to awakening critical thinking and considering scientific validity as vital. Continuing education and leadership by advanced practice nurses are two strong levers to acculturate registered nurses to gaining empowerment, improving their ability to question practices, helping them adapt to increasing the quality of care and making oncology nursing care more efficient. For cancer nurses in France, research education is the challenge to be met.

Empowerment Through Participation in a Cancer Prevention Exhibit: Evidence from the Hygée Lab Intervention.

While many countries have launched cancer prevention initiatives to improve the public's understanding of risk and protective factors, few are systematically evaluated. Hygée Lab, a living lab in a socioeconomically deprived area of France, is designed to interactively communicate evidence-based information about cancer prevention and treatment with the goal to improve visitors' understanding of cancer risk and prevention factors, reduce fatalism in regard to cancer, and increase feelings of empowerment. Pre- and post-visit data were collected during the first 18 months of the exhibit's opening from two segments of the population: adolescents from local schools (N = 134) and the general public (N = 112). Adolescents from the same schools who did not participate in the visit comprised the control group (N = 94). A further 232 general public visitors completed post-surveys only. Pre-post-visit comparisons reveal significant changes in both adolescent and general public visitors: cancer understanding improves, fatalism in regard to cancer is reduced, and feelings of empowerment increase. This systematic evaluation of Hygée Lab offers promise for how interactive exhibits may be used for cancer prevention amongst low health literacy populations.

Actions Speak Louder than Words: How Characters' Effectiveness as Message Sources Depend on Their Story Experiences.

A television (TV) character's actions and the consequences of these actions in TV storylines can shape the audience's own behavioral intentions, especially if the audience identifies with that character. The current research examines how storylines depicting positive versus negative consequences of drinking affect youths' drinking intentions, and whether post-narrative intervention messages delivered by story characters alter these influences. Results indicate that a post-narrative intervention can correct drinking intentions shaped by a pro-alcohol storyline, but the effectiveness depends on the source: a peripheral character is more effective than the main character at delivering a corrective message. This research pinpoints the role of identification with the main character as a key driver of stories' influence and a key focus of health intervention efforts to correct these stories' potentially undesirable impact on vulnerable audiences.

Conditions for the Implementation of a Patient Education Program Dedicated to Cancer Patients Treated by Oral Anticancer Therapy.

INTRODUCTION: A patient education program has been developed in the field of cancer for supporting cancer patients undergoing oral anticancer therapies. Its implementation was tested in 3 different settings. The objectives of this study were to 1) identify barriers and facilitators for implementing the patient education program, 2) identify practices encouraging or hindering implementation and 3) produce recommendations for its dissemination. METHODS: Twenty semi-structured interviews were conducted with caregivers from all three establishments. RESULTS: The main factors associated with successful implementation were as follows: prescribers' representations on patient education, considered of low value; on oral anticancer therapies, considered too dangerous to be handled by the patient him/herself, the indefinite legitimacy of certain professions in charge of patient education programs; patients' engagement in their care pathway and provision of caregivers. CONCLUSION: Recommendations include developing patient education culture within the environment of the medical doctors' curriculum, to consider contextual, pre-existing cooperative units for implementing patient education, to systematically send patients to patient education programs without practicing triage. Successful implementation of patient education critically depends on the prescribing physicians' perceived value of patient education. Patient education should become mandatory, integrated as part of the cancer care pathway. Physicians lack the necessary time and/or means to assess patients' capacity for engagement, without adequate strategies for their support. Therefore, physicians should systematically refer all patients to patient education, where nurses can tailor their coaching of cancer patients. TRIAL REGISTRATION: The study protocol was approved by the IRB SUD EST I (N° EudraCT: 2016-A00113-48). All participants were given written and verbal information about the study and gave informed consent to participate.

Managing unresolved issues of addiction during cancer treatment: A qualitative study about cancer care providers' representations.

OBJECTIVE: Five French oncology institutions had participated in a funded study aiming at implementing an Evidence-Based Practice tool (PAM-13), which allowed nurses to measure the level of activation of the patient to support his or her own empowerment in the cancer care pathway. The purpose of this ancillary study is to (i) describe the caregivers' perceptions of addictions and their management concurrently with cancer treatment, (ii) explore the role that Motivational Interviewing techniques can play. METHODS: 15 individual semi-structured interviews of caregivers were performed, using the Theoretical Domains Framework for the interview guide. Qualitative data were analyzed inductively, in a thematic analysis. The COREQ guided the reporting of this qualitative study. RESULTS: Views on addictions influence the way caregivers manage patients suffering from unresolved issues of addiction. Care is mainly focused on the pathology (cancer-centered) and strictly curative. When practiced, Motivational Interviewing is patient-centered, fostering the patient's empowerment on the cancer care pathway. CONCLUSIONS: The dissemination of Motivational Interviewing techniques in current practices in oncology, both in terms of doctors and nursing teams, would enable improvement to the management of addictions on the cancer care pathway, by deploying a patient-centered approach. This new paradigm of care would support the empowerment of patients enrolled in the cancer care pathway and promote better communication between caregivers and patients. Hence, a paradigm shift is essential. Motivational Interviewing techniques could provide a caring approach that promotes communication between the patient and the caregiver and also supports the former's empowerment. This research suggests the need to adapt the cancer care pathway in order to integrate the necessary care for patients who concomitantly suffer from unresolved addictive disorders. TRIAL REGISTRATION: NCT03706937.

Social Networking Sites and Perceived Content Influence: An Exploratory Analysis from Focus Groups with French Adolescents.

Social networking sites (SNSs) are invested in heavily by marketers aiming to reach a growing number of consumers. Concerns regarding the influence of posts displayed on SNSs in relation to behaviour were raised, in particular the promotion of ill-health behaviour directed to adolescents who may be at risk from suggestible practices. Although adolescents tend to be critical towards traditional forms of advertising, little is known about their perception of influencing strategies developed online, especially where sponsor- and user-generated content coexist. This exploratory study aims to gather information directly from adolescents about their use of SNSs their awareness of the influence that SNS content may have, particularly when it comes to tobacco and alcohol messages. Ten focus groups were conducted with 39 adolescents (11-16 years old; 56.4% male). Qualitative analysis documents the differences associated with adolescents' favourite SNSs. The different parameters linked to each SNS and the expectation to find entertaining content and values associated with friendship may decrease adolescents' perception of potential risk for health associated with SNS use. Authors advocate for the development of educational programs based on eHealth literacy and the use of social marketing techniques to facilitate and motivate adolescents to develop their competences.

Alcohol in TV series popular with teens: a content analysis of TV series in France 22 years after a restrictive law.

BACKGROUND: European citizens are the largest alcohol users in the world with an average of 11 l of alcohol per individual per year being used. This consumption practice usually begins during adolescence. Youths' views of substances consumption are built upon socialization experiments from which television takes part. To prevent vulnerable people from media influence, some governments tend to adopt restrictive laws against alcohol marketing within the public space including TV programmes; others rely on the self-control of the alcohol and/or media industry. More than 22 years ago, France adopted a restrictive law made of measures aiming to regulate or prohibit advertising of alcoholic products, especially within media dedicated to minors. METHODS: This study relies on a content analysis to identify the patterns and the frequencies of occurrences linked to alcohol within a sample of 14 TV series (8 French series and 6 American series) most watched by French teenagers. In total, 180 episodes have been analysed representing 111 h 24 min and 6 s of series coded. RESULTS: Alcohol is depicted within 87.8% of the sample. French series statistically show more events related to alcohol when compared to the American series. In French series, alcohol, mainly wine, is associated with a familiar lifestyle context with primary characters. CONCLUSION: The restrictive law ongoing in France does not prevent popular TV programmes watched by minors to depict alcohol. Concerns should be raised about the impact of the values given to the substance integrated to main characters life within the media.

[Smoking and alcohol cessation programs in patients with head and neck cancer]. / Accompagnement des dépendances à l'alcool et au tabac des patients atteints d'un cancer des voies aérodigestives supérieures.

Most head and neck cancers are associated with smoking and alcohol exposure. Smoking and alcohol cessation (ASC) is associated with improved quality of life, cancer therapy efficacy, decreased treatment-related and cardiovascular risks, and is expected to decrease the risk of second primary tumor. It is therefore a high priority in the plan of care. However, results of current ASC programs are disappointing and understanding the reasons of this is critical. We started a qualitative study in 6 academic centers including 3 university hospitals, one regional hospital and one comprehensive cancer center. We first interviewed surgeons and care givers involved in the management of head and neck cancers. Poor communication between stakeholders, absence of alignment of care goals between patients, surgeons and other caregivers, and low level of understanding by patients of the benefits of ASC were felt to represent frequent obstacles to successful outcome. More work is ongoing within the context of our IHNPACT umbrella protocol to identify hurdles associated with successful ASC.

The impact of social inequalities on children's knowledge and representation of health and cancer.

Reducing inequalities in the field of cancer involves studying the knowledge and mental representations of cancer among children. A qualitative study was conducted on 191 children aged 9 to 12 using the "write and draw" technique to get spontaneous mental representations of "healthy things", "unhealthy things" and "cancer". We grouped the voluntary schools according to two deprivation levels. In response to the request to "write or draw anything you think keeps you healthy", the main responses categories were physical activity, healthy food and basic needs. Smoking, drinking alcohol, sedentary lifestyles/lack of sport were identified as "unhealthy". The first theme associated with "cancer" is the "cancer site" implying children have a segmented perception of cancer. Deprived children have radically different views about the key items representing cancer: they are more likely to believe the illness is systematically deadly. They are less likely to believe it is a treatable illness. They are less likely to associate cancer with risky behaviors, particularly alcohol consumption. CONCLUSION: Social inequalities affect representations of cancer and health literacy from early childhood. Prevention programs taking into account these representations need to be introduced at school. What is Known: • Social inequalities for cancer mortality are observed in all European countries and are particularly pronounced in France. • Reducing these inequalities in prevention programs implies studying the knowledge and mental representations of cancer among children. What is New: • This study identified representations of cancer in young children according to social level. • At age 9, children living in deprived areas are less able to produce content in discussions about cancer and have narrower mental representations and a more fatalistic view.

Impact of Substance Messages in Music Videos on Youth: Beware the Influence of Connectedness and Its Potential Prevention-Shielding Effect.

OBJECTIVE: Two studies were conducted to investigate the role of connectedness with music videos in affecting youths' beliefs about substances (alcohol and tobacco) embedded therein and the potential for a prevention message to limit the impact of these images. METHOD: The first study used cross-sectional data from a national sample of 1,023 adolescents (54.3% male) to evaluate the relationship between youths' consumption of music videos and their beliefs about the consequences of consuming alcohol and tobacco. A controlled experiment with 151 participants (57% male) then tested whether exposure to smoking in a video affects youths' smoking beliefs and the preventive potential of a pre-video warning. RESULTS: Connectedness to music videos, not overall amount of viewing, is the main correlate of beliefs about the positive outcomes of consuming alcohol/tobacco. A single exposure to a music video with smoking images can increase beliefs that smoking leads to positive consequences, and connected viewers are especially receptive to these images. Alerting youths to the presence of substance messages in a video leads to differential results as a function of connectedness. CONCLUSIONS: Many youths spend hours every day watching music videos in which positive visuals about drinking and smoking abound. Rather than the quantity of viewing, it is the degree to which youths immerse themselves in these music videos that enhances their beliefs that smoking and drinking have positive consequences. Interventions that warn youths about the presence of substances in music videos can minimize their influence, but youths highly connected with the music video content are especially resistant to warnings.

Inequalities and Barriers to the Use of Supportive Care Among Young Breast Cancer Survivors: a Qualitative Understanding.

The development of supportive care for cancer patients has been shown to have a positive impact on both mortality rates and many aspects of life after cancer, particularly in young women. Meanwhile, there are still numerous inequalities in terms of cancer mortalities and quality of life among cancer survivors in France. The processes leading to unequal access to supportive care services, and the impact this has on the post-treatment period, have been poorly documented, however. The goal of this study was to understand the barriers to using supportive care services among young women breast cancer survivors under the age of 50 and to find out how this can contribute to inequalities. Thirty-six young breast cancer survivors, one third of which deemed socially deprived, were interviewed using a qualitative, inductive approach at two comprehensive care centres in France. Our findings primarily show that there are still a number of barriers to accessing supportive care for a large number of patients. The way information about supportive services is delivered is a major cause of inequalities in the use of these services. The guidance provided does not take into account either the patients' needs or their capacity to integrate the information and anticipate problems. Certain specific post-treatment issues have yet to be addressed. Some systemic barriers could be lifted by changing the way information on supportive care services is currently organised and thereby prevent the survivorship plans now being implemented in cancer care settings from reinforcing health inequalities.

Improving Adherence to Adjuvant Endocrine Therapy in Breast Cancer Through a Therapeutic Educational Approach: A Feasibility Study
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PURPOSE/OBJECTIVES: To develop and test the feasibility of a tailored therapeutic educational program, with the aim of improving adherence to oral endocrine adjuvant chemotherapy in women with breast cancer. 
. DESIGN: A qualitative study to identify educational needs and a feasibility study assessing the efficacy of the program.
. SETTING: A comprehensive cancer center, the Lucien Neuwirth Cancer Institute in Saint-Priest-en-Jarez, France.
. SAMPLE: Two consecutive samples (N = 11, N = 6) of women taking adjuvant oral endocrine chemotherapy for breast cancer. 
. METHODS: A mixed qualitative and quantitative method was used. The participants' representations of disease and treatment were explored through one-on-one interviews and then translated into educational needs, which were used to develop a tailored therapeutic education program. The pilot study evaluated the reach and efficacy using before-and-after comparisons. 
. MAIN RESEARCH VARIABLES: Educational objectives, knowledge, trust in the treatment, and anxiety.
. FINDINGS: Five educational objectives (acquiring knowledge, improving communication skills, managing anxiety, managing side effects, and improving adherence) were identified through 11 interviews. A three-session program was developed. Eight of the 23 patients invited to participate in a pilot study accepted, and six completed the intervention. Knowledge improved from 38.9 of 100 preintervention to 69.4 of 100 postintervention (p = 0.045). Trust in treatment showed a trend to improvement from 5.5 of 10 to 8 of 10 (p = 0.14), but anxiety did not change significantly; anxiety went from 6 to 7 (p = 0.88).
. CONCLUSIONS: Results from the feasibility study showed promising efficacy for the educational objectives and provided information about how the program could be improved. 
. IMPLICATIONS FOR NURSING: Tailored educational programs conducted by trained nurses may help patients to adhere to and live with the effects of endocrine therapy.

[Validation of a questionnaire assessing patients' adherence and skill level of management for oral capecitabine treatment]. / Validation d'un questionnaire mesurant l'adhérence et les compétences de gestion des effets secondaires chez des patients traités par capécitabine.

INTRODUCTION: There is a plea for the development of tools allowing the screening of fragile patients under oral chemotherapy. Such tools would identify patients with difficulties for being adherent or for having low side effects management skills. The aim of this study is to validate psychometric characteristics of a questionnaire assessing patients' adherence and skill level of management for oral capecitabine treatment. METHODS: Questionnaire's psychometric validation study. Prospective monocentric cohort. Cases-simulated questionnaire was constructed, according to recommendations, from the results of a socio-anthropological study. Validation phases included: a pre-testing and a field-testing including acceptability, scale reliability and internal consistency were conducted involving experts and patients sample. RESULTS: Pre-testing excluded 1 item. Acceptability phase included 15 patients, who did not change any of the questions. Reliability and internal consistency were tested with 67 patients. Cancer site did not statistically influence questionnaire answers. No correlation was identify with the analyse performed for the internal consistency testing. CONCLUSION: This questionnaire has shown to be a valid tool for the assessment of the adherence and side effect management skill for patients with capecitabine treatment. It can easily be uses as a screening tool for prescribers. It can also be used as an evaluation tool for a therapeutic education programme in this field.

[Organized or individual breast cancer screening: what motivates women?]. / Dépistage organisé ou individuel du cancer du sein ? Attitudes et représentations des femmes.

OBJECTIVE: The breast cancer screening programme, proposed to all women between 50 and 69 years, consisting of two-view mammography screening every two years, has been generalized in France since 2004. The programme coexists with opportunistic mammography screening, provided outside official frameworks. This qualitative study was designed to identify the pros and cons of these two screening modes. METHODS: Three hundred and forty-five women were randomly selected from women who had participated in a previous quantitative study and who were invited to attend for breast cancer screening in 13 French departments between 2010 and 2011. These women were asked to participate in a face-to-face semistructured interview conducted by a sociologist. RESULTS: 48 women (17 from deprived areas) were interviewed. All chose to be screened for breast cancer either because they feared cancer, or because they wanted to control their own health. Twenty-seven women chose the organized screening programme, which they considered to be trustworthy, as negative mammograms are double checked by a second radiologist. Twenty-one women preferred individual screening, which they considered to be more reliable, less anonymous and providing them with more liberty to take control of their own health. CONCLUSION: Gynaecologists play an important role in women's decision to undergo individual breast cancer screening. They also have an important role to play in the promotion of organized breast cancer screening programme with this public.