Educating patients in a French cancer treatment center: How to ensure therapy safety while reckoning patients' knowledge and power to act.

In this article, we analyse how health professionals educate cancer patients to care for their condition and keep strict control over therapy safety. We study how much room for negotiation is left to patients during medical consultations so resources can still be exchanged. We pay particular attention to the trade of knowledge and powers between patients and doctors (power to act and to express oneself in an imbalanced relationship where knowledge is unequally shared). We opted for a qualitative approach with 41 interviews and several ethnological observations, first of consultations in haematology, then of pre-planned phone calls made to patients during the course of a cancer therapy follow-up scheme. The declared ambition of turning cancer patients into self-responsible patients actually re-enacts well-known procedures of control and knowledge acquisition aimed at narrowing their margin of manoeuvre for the sake of therapy safety. Even if some freedom is conceded, patients remain under the control of their medical hierarchy. Health professionals privilege two methods to keep control over patients and teach them therapy safety procedures. Which method is chosen, and how it is used, is dictated by the relationship between socially-diverse patients and health professionals. In the end, what the patient learns and the amount of control the doctor keeps over this process will depend on the distribution of power and knowledge among them, but asymmetry will always remain.

Récit de soi en éducation thérapeutique du patient : valoriser des biographies ajustées au registre clinique.

This article examines the self-narrative in interactions between patients and with caregivers who participate in a Patient Therapeutic Education (TPE) program on the self-management of oral cancer drugs. This program has the particularity of combining the objectives of acquiring knowledge and verbalizing the experience with a group of patients. We analyze the effects of socializations and interactions between participants (patients and caregivers) on self-narratives and knowledge sharing in TPE. An ethnographic survey of the TPE workshops was carried out over the course of more than two years interviews with 24 participants (professionals and patients) previously observed also made it possible to review their experience of TPE. We start from the premise that self-narratives are part of a legitimate body of knowledge but that they are more or less visible in the context of TPE workshops. We observe in patients a variation in their story depending on the legitimacy granted to their experience and their ability to translate it into a heterogeneous collective. We also show how the interactions between patients and the facilitation of caregivers enhance the stories that align with the principle of patient empowerment and invisible or even obscure others in the name of this same concern.

Integrating Multidisciplinary Results to Produce New Knowledge About the Physician-Patient Relationship: A Methodology Applied to the INTERMEDE Project.

The INTERMEDE Project brought together a number of research teams to study the interaction between a patient and their general practitioner, and how this can produce social inequalities in health. The ultimate objective of the project was to formalize a core of common findings by integrating qualitative and quantitative results. The methodology chosen for the integration was inspired by the Delphi participatory method. It involves several rounds of questions and feedback in writing between all members of project teams, in order to compare contradictory opinions and identify key concepts arising from the project. This interdisciplinary research has provided a more nuanced understanding of the mechanisms underlying physician-patient interaction by revealing the convergences of the various disciplinary approaches.

Enabling the transferability of complex interventions: exploring the combination of an intervention's key functions and implementation.

OBJECTIVES: Several public health interventions are not described, not evaluated and not transferred. The objective was to assess the feasibility and acceptability of using a description model making a distinction between interventions' transferable elements, and those that are more context-specific, to make their evaluation and transferability easier. METHODS: The theoretical distinction between an intervention function and its form in a specific context has been empirically explored. A community-based intervention (named "Ciné-Ma-Santé") has been described, using a "key function/implementation/context" model. This process has been co-constructed through qualitative research and knowledge exchange process between project leaders and researchers from different disciplines. RESULTS: The use of the model proves feasible and useful for both project leaders and researchers. Nine key functions were described, as well as their implementation and the features of the intervention context. CONCLUSIONS: Rendering explicit key functions of public health interventions could constitute a useful step to their evaluation and transfer. It enables the formulation of hypotheses regarding the potentially standardizable elements of interventions, and elements that can be modified while maintaining the integrity of the intervention.