[Experience of medical oncologists when telling a patient to be referred to a palliative care unit]. / Vécu chez les oncologues médicaux de l'annonce du transfert en unité de soins palliatifs à l'un de leurs patients.

INTRODUCTION: The announcement of the cessation of cancer treatments is a moment unanimously recognized as difficult for oncologists. More rarely analyzed, the announcement of a transfer to palliative care units is just as much. However, understanding the experience of oncologists during this announcement could make it possible to optimize it. MATERIALS AND METHODS: Qualitative, prospective, monocentric study with medical oncologists. Semi-structured interviews with 7 open questions. RESULTS AND DISCUSSION: Twelve interviews were conducted with a sex ratio of seven women for five men and an average age of 41.9 years. Six themes emerge after horizontal analysis of the verbatim and triangulation of the data. The experience of oncologists is dominated by a feeling of guilt, of fear of causing death anxiety in the patient, and of failure and helplessness in in front of a short-term vital risk. There is also a feeling of frustration at not being able to go through with the care. Facing the escape of the disease, oncologists feel resigned. We also observe projections on the part of oncologists with patients and paramedics. Finally, the existential question of death is an omnipresent concern with the feeling of abandoning the patient and a questioning of skills. However, it seems that the collaboration with the mobile palliative care team (EMSP) and the prospect of creating an internal palliative care unit (USP) at the center are perceived as a help.

Issues of mindfulness implementation for oncology caregivers.

OBJECTIVES: Burn out is high in oncology. We aim to evaluate the feasibility and identify the barriers for mindfulness implementation in oncology professionals. METHODS: We conducted a pilot study in which voluntary oncology caregivers entered mindfulness workshops, and complete online questionnaires. We also conducted a qualitative study to better identify the practical reasons which hamper the implementation of mindfulness in oncology caregivers having refused to participate. RESULTS: 83.3% of volunteers for the workshops were women, 60.00% (16/30) of caregivers completed the program. Caregivers' resistances to mindfulness practice were: a lack of availability and information, complex organisation with limited free time, and accept spending time to take care of themselves. CONCLUSIONS: This work highlights the interest of mindfulness for caregivers in oncology, we have identified specific issues hindering the implementation of such technique which can be further investigated.

Virtual reality distraction during uterovaginal brachytherapy applicators' removal: A pilot comparative study.

PURPOSE: To assess the relevance of virtual reality distraction (VR) during uterovaginal brachytherapy applicators' removal, as an alternative to nitrous oxide (N2O) conscious sedation, to decrease anxiety and pain perception. METHODS AND MATERIALS: We prospectively evaluated 35 patients treated with cervical brachytherapy for locally or locally advanced cervical cancer. Brachytherapy applicators were removed in the patient's room at the end of the treatment. Patients were assigned to N2O conscious sedation (reference group) or VR (experimental group). Anxiety and pain were evaluated with the STAI-E score and with Visual Analogical Scales (VAS). RESULTS: Fourteen patients were treated with VR and 21 with N2O. STAI-E baselines scores were 35 in the VR group and 38 in the reference group and declined to 30 and 28, respectively after procedure. The mean VAS-anxiety was 2.9 before and 2.7 at the peak in the VR group versus 4.1 and 1.6, respectively in the reference group. The mean VAS-pain was 1.0 before, 3.1 at the peak and 0.4 after the procedure in the experimental group, versus 1.8, 2.0, and 0.6 respectively in the N2O group. Four patients in the VR group experienced mild nausea/vomiting or dizziness during the procedure. The preparation duration was higher in the VR group, with a similar duration for the removal itself. CONCLUSIONS: Replacing a medical gas by a virtual reality device was feasible and led to acceptable levels of pain and anxiety. Prospective randomized trials are needed to confirm efficacy and to determine which patients could benefit the most from this approach.

Barriers to the Prevention of Suicide in Nursing Homes.

BACKGROUND: The suicide rate in older people is high. Gatekeeper training is recommended for at-risk populations in the detection and management of suicidal residents in nursing homes. AIMS: This study focuses on how caregivers in nursing homes consider suicide in older people from a social perspective, and to what extent these social representations are an obstacle to the prevention of suicide. METHOD: This study is both observational and qualitative, and is based on semi-directed one-to-one interviews with caregivers. RESULTS: We met with 18 caregivers from three nursing homes in 2015. We show that the social representations of caregivers working in nursing homes are essentially identical to those of the general population and those found in other studies on paramedics. Suicide is seen as an expression of autonomy, a response to the suffering associated with aging and the living conditions imposed on older people in our society, particularly in nursing homes. LIMITATIONS: Our study highlights the problems inherent to the position of caregiver, in which we can observe a conflict between professional missions and personal ideology. CONCLUSION: This study confirms the need to continue training on suicide prevention in nursing homes.

Characteristics of socially withdrawn youth in France: A retrospective study.

BACKGROUND: Poor social interactions have been recognized as a symptom since the beginnings of psychiatry. As far as socially withdrawn youth (SWY) are concerned, studies were mostly conducted on patients seeking care. Our psychiatric outreach team called Psymobile was able to reach SWY patients who were not seeking mental health care. AIMS: To identify the clinical and socio-demographic characteristics of SWY patients referred to our Psymobile unit. METHOD: We carried out a retrospective study on the records of patients aged 18-34 years, who were referred to Psymobile for 'withdrawal', between April 2012 and December 2015. RESULTS: In total, 66 patients were included in the study. SWY are predominantly male (80%) from large families or single-parent ones. About 42% had no prior contact with a mental health professional before being referred to Psymobile. The mean duration of withdrawal is 29 months. In all, 42% of SWY use cannabis and 73% present disorders of the sleep-wake schedule. About 71% maintain relations with their families and 73% go out occasionally. They are mostly diagnosed with schizophrenia (37%) or mood disorders (23%). CONCLUSION: Over one-third of Psymobile patients aged 18-34 years were referred on grounds of social withdrawal. Our data may illustrate more accurately the situation of youth social withdrawal amid the general population than data from help-seeking patients or online questionnaires.