An Integrated Cancer Prevention Strategy: the Viewpoint of the Leon Berard Comprehensive Cancer Center Lyon, France.

This article describes some of the key prevention services in the Leon Berard Comprehensive Cancer Center (CLB) Lyon, France, which are based on clinical prevention services, outreach activities, and collaboration with professional and territorial health communities. In addition, research is embedded at all stages of the prevention continuum, from understanding cancer causes through to the implementation of prevention interventions during and after cancer. Health promotion activities in the community and dedicated outpatient primary cancer prevention services for individuals at increased risk have been implemented. The CLB's experience illustrates how prevention can be integrated into the comprehensive mission of cancer centers, and how in turn, the cancer centers may contribute to bridging the current fragmentation between cancer care and the different components of primary, secondary, and tertiary prevention. With increasing cancer incidence, the shift toward integrated prevention-centered cancer care is not only key for improving population health, but this may also provide a response to the shortage of hospital staff and overcrowding in cancer services, as well as offer opportunities to reduce carbon emissions from cancer care.

Association between emotional competence and risk of unmet supportive care needs in caregivers of cancer patients at the beginning of care.

PURPOSE: This cross-sectional study explored the associations between intrapersonal and interpersonal emotional competence (EC) and the unmet supportive care needs (SCN), anxiety, and depression of informal caregivers at the beginning of gastrointestinal or haematological cancer care, i.e. during chemotherapy and within 6 months after diagnosis. METHODS: The participants completed a self-reported questionnaire, comprising the Short Profile of Emotional Competence (S-PEC), the SCN survey for partners and caregivers (SCNS-P&C), and the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression models were performed to explore the influence of EC on unmet SCN and the presence of moderate/severe anxiety or depression. RESULTS: Most of the 203 caregivers were women (n = 141, 69.80%) and the partners of patients (n = 148, 73.27%) suffering from gastrointestinal (n = 112, 55.17%) and haematological (n = 91, 44.83%) cancer. Only intrapersonal EC showed a significant influence out of all the dimensions of unmet SCN related to healthcare services and information (odds ratio (OR) = 0.35 [95%CI 0.19; 0.65]), emotional and psychological needs (OR = 0.43 [95%CI 0.25; 0.74]), work and social security (OR = 0.57 [95%CI 0.37; 0.88]), and communication and family support (OR = 0.61 [95%CI 0.39; 0.95]). A one-unit increase in the intrapersonal EC score significantly reduced the probability of anxiety (OR = 0.42, [95%CI 0.26; 0.68]) and depression (OR = 0.34, [95%CI 0.21; 0.55]). CONCLUSION: Intrapersonal EC of caregivers is crucial to reduce the risk of unmet SCN, anxiety, and depression from the beginning of care. Identifying caregivers with lower intrapersonal EC may be necessary to increase vigilance from healthcare professionals and psychologists.

Happy thus survivor? A systematic review and meta-analysis on the association between cancer survival and positive states, emotions, and traits.

OBJECTIVES: Traditionally, the literature investigating patient-reported outcomes in relation to cancer survival focused on negative factors such as distress. Meta-analyses in this field have provided a clear identification of negative affect that reduce cancer survival (e.g., depression). Nevertheless, positive psychological factors and especially positive affect might be equally crucial for cancer survival but have been neglected so far. While studies in this domain have been conducted, they remain less numerous and have produced mixed results. METHODS: A pre-registered systematic review and meta-analysis (https://osf.io/jtw7x) aimed at identifying the positive affect linked to mortality in cancers were conducted. Four databases (Pubmed, PsycINFO, Embase, and Cochrane Library) were searched to find longitudinal studies linking positive affect to survival in cancers. Two reviewers completed each stage of the study selection process, the data extraction, and the Quality in Prognosis Studies risk of bias assessments. RESULTS: Twenty-four studies involving 822,789 patients were included based on the 2462 references identified. The meta-analysis reveals that positive affect is associated with longer survival (Hazard Ratio [HR] = 0.91; 95% CI [0.86, 0.96], z = -3.58, p < 0.001) and lower mortality (Odd Ratio [OR] = 0.59; 95% CI [0.45, 0.78], z = -3.70, p < 0.001). Sub-group analyses indicated that the main predictors of survival are emotional and physical well-being, optimism, and vitality. CONCLUSION: This work emphasizes the need to consider the role of affective mechanisms in patients with cancer, including their levels of well-being or optimism to provide the most favorable conditions for survival. Therefore, stronger and continuous effort to improve patients' positive affect could be particularly beneficial for their life expectancy.

Caregivers' perception of patients' interpersonal and psychiatric alterations: What is the impact on their health?

PURPOSE: Previous research conducted among caregivers of patients with cancer revealed a poor Quality of Life (QoL) and high levels of distress. In addition to the influence of patients' clinical state, caregivers' appraisals of patients' difficulties should be considered as another predictor of poor caregiver health. This study aims to test the association between caregivers' health (i.e., QoL, depression and anxiety) and their perception of patients' difficulties. METHODS: 199 caregivers of patients with cancer completed an online survey based on questionnaires measuring their QoL, depression and anxiety, as well as their perception of patients' cognitive, emotional, functional, psychiatric and interpersonal difficulties. RESULTS: It was found that the appraisal of patients' impairments in all domains was mainly correlated with poor caregivers' QoL (Pearson correlations ranged from 0.14 to 0.45; p ≤ .05). Furthermore, linear regression analyses showed that, after controlling for age, sex education level, professional activity and living with or without the patient, the appraisal of patients' interpersonal abilities (ß = 0.25, p ≤ .05), psychiatric difficulties (ß = -0.25, p ≤ .01) and living with the patient were the main predictors of caregivers' QoL. CONCLUSION: This study highlights the importance of better understanding the role of patients' social and psychiatric difficulties when examining caregivers' health. This indicates the importance of providing support and offering information to caregivers to alert them to the role of patients' social and psychiatric difficulties on their own health. Future studies should better understand how these difficulties are associated with caregivers' perception of identity/sociability alterations in patients and how caregivers cope with these changes.

Emotional distress, supportive care needs and age in the prediction of quality of life of cancer patients' caregivers: A cross-sectional study.

INTRODUCTION: The existing literature shows a significant impact of cancer on caregivers' quality of life (QoL) and divergent results according to associated factors. To better understand the experience of cancer patients' caregivers, the present study aimed at comparing caregivers' QoL according to cancer care pathway and type of cancer, and at identifying the factors associated with their QoL. METHODS: Caregivers were included in the study either during chemotherapy or follow-up to assess their QoL (CARGOQoL), unmet supportive care needs (SCNS-P&C), and anxiety and depression levels (HADS). CARGOQoL scores were then compared using ANOVA or Mann-Whitney non-parametric tests (objective 1). Based on univariate analyses, a multivariate analysis of covariance or linear regression model was performed for each CARGOQoL dimension (objective 2). RESULTS: Among 583 participants (57.29% included during the follow-up phase), 523 completed the questionnaires. There was no effect of treatment phase and little effect of cancer site or disease stage on caregivers' QoL. Although significant factors associated with caregivers' QoL varied according to the dimensions assessed, the main associated factors were psychological experience (p < 0.05), satisfaction with the patient's care and supportive care needs (p < 0.01), and age of the patient or caregiver (p < 0.005). CONCLUSION: This study shows the necessity to support caregivers during both active treatment and follow-up. It highlights the crucial role of emotional distress, supportive care and age in caregivers' QoL, regardless of the patients' oncological status.

The association of physician empathy with cancer patient outcomes: A meta-analysis.

OBJECTIVE: In oncology, research remains unclear as to whether physician empathy is associated with patient outcomes. Our goal was to answer this question and explore potential moderators of the association. METHODS: In this meta-analysis on adult cancer care, we excluded randomised controlled trials, and studies of survivors without active disease or involving analogue patients. Eight databases were searched, in addition to reference lists of relevant articles and grey literature. Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence by using the AXIS tool. Effect size correlations (ESr) were chosen and pooled by using a random effect model. Subgroup analyses were performed, and statistically significant variables were introduced in a meta-regression. Several methods were used to explore heterogeneity and publication biases. RESULTS: We included 55 articles, yielding 55 ESr (n = 12,976 patients). Physician empathy was associated with favourable patient outcomes: ESr = 0.23, 95% confidence interval (CI) (0.18 to 0.27), z = 9.58, p < 0.001. However, heterogeneity was high, as reflected by a large prediction interval, 95% (-0.07 to 0.49) and I2 = 94.5%. The meta-regression explained 53% of variance. Prospective designs and physician empathy assessed by researchers, compared with patient-reported empathy, decreased ESr. Bad-news consultations, compared with all other types of clinical encounters, tended to increase ESr. CONCLUSION: Patient-reported physician empathy is significantly associated with cancer patient outcomes. However, the high heterogeneity warrants further longitudinal studies to disentangle the conditions under which physician empathy can help patients. Recommendations are proposed for future research.

Health Workers' Perception and Emotions Surrounding Teleconsultation in Pediatric Cancer Care During the COVID-19 Pandemic.

BACKGROUND AND AIMS: During the first lockdown of the coronavirus disease 2019 (COVID-19) pandemic, we developed a teleconsultation model and conducted a survey-based study with the aim to evaluate satisfaction and emotions of health workers (HWs), to assess the feasibility of teleconsultations, and to evaluate technical issues. MATERIALS AND METHODS: This is a prospective monocentric exploratory study based on synchronous, video consultations between HWs and pediatric patients treated for blood or solid malignancies or blood benign diseases. Every HW completed an online survey which covered technical aspects, data concerning satisfaction, quality of the interaction with the patient, and emotions felt after the teleconsultation. A score was calculated for each aspect. RESULTS: Eleven specialists participated in the study, and we selected 84 questionnaires. With a satisfaction rate of 74%, HWs felt mostly calm (80%), relaxed (70%), stress-free (69%), and relieved (65%). We calculated the following median scores: an overall satisfaction score of 6.67 (0 to 10), a global feeling score of 8.79 (3.33 to 10.00), and a quality score of 7.34 (2.50 to 10.00). A strong correlation between the quality of teleconsultation and the satisfaction of the HWs has been highlighted ( r =0.588). CONCLUSION: Our series is an encouragingly positive experience from the perspective of the HWs, their feelings, and perceptions.

Emotional processes in partners' quality of life at various stages of breast cancer pathway: a longitudinal study.

INTRODUCTION: Several studies have shown that emotional competence (EC) impacts cancer adjustment via anxiety and depression symptoms. The objective was to test this model for the quality of life (QoL) of partners: first, the direct effect of partners' EC on their QoL, anxiety and depression symptoms after cancer diagnosis (T1), after chemotherapy (T2) and after radiotherapy (T3); Second, the indirect effects of partners' EC at T1 on their QoL at T2 and T3 through anxiety and depression symptoms. METHODS: 192 partners of women with breast cancer completed a questionnaire at T1, T2 and T3 to assess their EC (PEC), anxiety and depression symptoms (HADS) and QoL (Partner-YW-BCI). Partial correlations and regression analyses were performed to test direct and indirect effects of EC on issues. RESULTS: EC at T1 predicted fewer anxiety and depression symptoms at each time and all dimensions of QoL, except for career management and financial difficulties. EC showed different significant indirect effects (i.e. via anxiety or depression symptoms) on all sub-dimensions of QoL, except for financial difficulties, according to the step of care pathway (T2 and T3). Anxiety and depression played a different role in the psychological processes that influence QoL. CONCLUSION: Findings confirm the importance of taking emotional processes into account in the adjustment of partners, especially regarding their QoL and the support they may provide to patients. It, thus, seems important to integrate EC in future health models and psychosocial interventions focused on partners or caregivers.

Unmet supportive care needs of caregivers according to medical settings of cancer patients: a cross-sectional study.

PURPOSE: The objectives of this study were to compare the unmet supportive care needs (SCN) of caregivers and describe the 10 most frequent of them according to various cancer settings: phase of cancer care pathway (i.e., treatment vs. follow-up), cancer site (i.e., breast, digestive, or lung cancer), and cancer status (i.e., metastatic vs. non-metastatic). METHODS: Participants completed a self-reported questionnaire to assess their unmet SCN (SCNS-P&C). According to their cancer settings, non-parametric ANOVA or Mann-Whitney tests were performed to compare the SCNS-P&C scores. The prevalence of caregivers with unmet SCN was described using percentages. RESULTS: Among 583 participants, 516 caregivers (88.5%) completed the SCNS-P&C questionnaire. Most patients had digestive (47.3%), non-metastatic cancer (67.6%) and were recruited during the follow-up phase (56.2%). The results revealed no significant difference in SCNS-P&C scores according to cancer settings except for caregivers of patients with metastatic cancer, who reported more unmet SCN related to health care service and information needs. The more qualitative item per item analysis seems to indicate the existence of five frequently unsatisfied SCN across situations, especially concerns about the recurrence and reduction of stress in patients, with variable ranking among the most unmet SCN. CONCLUSION: Although there was no significant difference in unmet SCN scores between medical settings, examining the prevalence of unmet SCN helps identify the issues to focus on when supporting caregivers and developing dedicated consultations or interventions for them.

[Integrative oncology: Report and place for a dedicated consultation in a comprehensive cancer center]. / L'oncologie intégrative : état des lieux et place d'une consultation dédiée dans un centre de lutte contre le cancer.

Progress in the care of cancer patients has brought out new needs that go beyond the scope of conventional medicine regularly. Integrative oncology allows patients, besides specific care, to access complementary therapies (CT); with the aim of improving in this case the quality of life and the future of the patients and to help them become actors, before, during and after the treatment of their cancer. As for breast cancer management, international recommendations have been given for several years in favor of the use of CT, especially mind-body therapies, and regarded as effective care. Being able to refer patients suffering from any tumors to CT, through a structured procedure, integrated into the care pathway, would improve overall cancer management and the quality of life of the patients during chemotherapy. Improved communication from the oncologist about CT could better the relationships between the oncologist and the patient, and would be a better way to reduce the choice of practices that might be at risk, while improving compliance with conventional treatment. In this context, we report the opening of an integrative oncology consultation within a comprehensive cancer center, detailing the procedure of the consultation, describing the patients and their expectations, as well as the proposals made to them. This type of consultation is still underdeveloped in France and will be the subject of studies in the field of Humanities and social sciences.

Reasons for acceptance and refusal of early palliative care in patients included in early-phase clinical trials in a regional comprehensive cancer centre in France: protocol for a qualitative study.

INTRODUCTION: A few studies have highlighted the potential synergy between early palliative care and inclusion in an early-phase clinical trial that may improve quality of life, reduce symptoms of exhaustion related to the side effects of treatment and allow patients to complete their treatment protocol. The primary objective of this qualitative study is to evaluate the reasons for acceptance or refusal of early palliative care in patients included in early-phase clinical trials. METHOD AND ANALYSIS: All patients from the Centre Léon Bérard (Comprehensive Cancer Centre in Lyon, France) who consent to one of the early-phase clinical trials proposed at the centre will be invited to participate in this study. The cohort will consist of a subgroup (n=20) of patients who accept palliative care together with their clinical trial, and a second subgroup (n=20) of patients who decline it. Patients will be interviewed in exploratory interviews conducted by a psychology researcher before the start of their clinical trial. The interviews will be audio-recorded. Patients will also be asked to complete quality of life and anxiety/depression questionnaires both before the beginning of the treatment and at the end of their clinical trial. The content of the interviews will be analysed thematically. Descriptive and comparative statistical analysis of both cohorts will also be conducted. ETHICS AND DISSEMINATION: Personal data will be collected and processed in accordance with the laws and regulations in force. All patients will give informed consent to participate. This study complies with reference methodology MR004 of the Commission Nationale de l'Informatique et des Libertés. The protocol has received the validation of an ethics committee (Groupe de Réflexion Ethique du CLB, number: 2020-006). The results will be disseminated through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT04717440.

Adjustment of young women with breast cancer after chemotherapy: A mediation model of emotional competence via emotional distress.

OBJECTIVE: Emotional competence (EC) is considered a substantial resource in the adjustment of cancer patients, especially via its effect on anxiety and depression symptoms. This research aimed at assessing the impact of intrapersonal EC in young women (≤45 years) with breast cancer (YWBC) on their specific quality of life (i.e. subjective experience related to daily difficulties and perceived repercussions of the disease and treatments) related to chemotherapy, via anxiety and depression symptoms. METHODS: Two hundred fifty YWBC from 24 French centers completed a self-reported questionnaire after diagnosis (T1) and after the chemotherapy phase (T2), comprising the Young Women Breast Cancer Inventory, the Profile of EC and the Hospital Anxiety and Depression Scale. The indirect effect of EC (T1) on subjective experience (T2) via anxiety and depression symptoms (T2) was tested using regressions and the Macro PROCESS. RESULTS: Emotional competence predicted fewer anxiety and depression symptoms at T1 and T2, and a better subjective experience at T2 via fewer anxiety and depression symptoms. Depression symptoms appeared to be a stronger mediator than anxiety symptoms on four dimensions (Support from close relatives, feeling of couple cohesion, body image and sexuality, management of children and everyday life), whereas anxiety symptoms appeared to be a stronger mediator on two dimensions (negative affectivity and apprehension about the future, deterioration of relationships). CONCLUSIONS: These results support the importance of developing psycho-affective interventions to reinforce the EC of YWBC during chemotherapy in order to facilitate the cognitive and emotional processes necessary for a better adjustment and subjective experience.

Perceived trajectory of psychological and physical states after breast cancer: An optimistic perception.

BACKGROUND: In cancer research, studying the quality of life trajectory helps us understand the complaints but also the cognitive, physical, and emotional aspects that can evolve positively. Examining both the suffering and the improvements expressed by the patients facilitates their care and their recovery knowing that an optimistic perception of the future is important for adaptative functioning after cancer. Through retrospective, present and prospective measures, we sought to characterize the subjective trajectory perceived by women with breast cancer about their cognitive, emotional and physical states, as it relates to quality of life. METHODS: Nine hundred ninety women survivors of breast cancer (after curative treatments) described, on the appropriate scales, their perceived cognitive, emotional and physical states over three periods of time: from past care (i.e., retrospective analysis) to the future (i.e., projective analysis), including the present period, as a function of their treatment (chemotherapy vs. no chemotherapy) and surgery (lumpectomy vs. mastectomy) using ANCOVA. RESULTS: The 732 women who had received chemotherapy perceived the most significant consequences, regardless of the type of surgery (η2= .01). Moreover, all survivors expressed an optimistic perception of the change in their states in the anticipated future as a normative optimistic perception. CONCLUSIONS: Results are discussed in terms of the benefits of specific and early interventions that enable patients to cope better with the disease and its treatments by taking into account their more or less optimistic perception of the future.

Associations between the severity of medical and surgical complications and perception of surgeon empathy in esophageal and gastric cancer patients.

OBJECTIVE: To assess the impact of global physician empathy and its three subdimensions (establishing rapport, emotional and cognitive processes) on the severity of postoperative complications in a sample of cancer patients. METHODS: We retrospectively analyzed data on 256 patients with esogastric cancer from the French national FREGAT database. Empathy and its subdimensions were assessed using the patient-reported CARE scale and the severity of medical and surgical complications was reported with the Clavien-Dindo classification system. The usual covariates were included in multinomial logistic regression analyses. RESULTS: Physician empathy predicted the odds of reporting major complications. When patients perceived high empathy, they were less likely to report major complications compared to no complications (OR = .95, 95% CI = [.91-.99], p = .029). Among the three dimensions, only "establishing rapport" (OR = .84, 95% CI = [.73-.98], p = .019) and the "emotional process" (OR = .85, 95% CI = [.74-.98], p = .022) predicted major complications. CONCLUSIONS: Physician empathy is essential before surgery. Further research is needed to understand the mechanisms associating empathy with health outcomes in cancer. Physicians should be trained to establish good rapport with patients, especially in the preoperative period.

Is the Postsurgical Quality of Life of Patients With Esophageal or Gastric Cancer Influenced by Emotional Competence and Neoadjuvant Treatments?

BACKGROUND: Emotional competence (EC) via anxiety and depressive symptoms impacts the postoperative health-related quality of life (HRQoL) of esophageal and gastric cancer patients after surgery. OBJECTIVE: The aim of this study was to confirm the involvement of emotional processes in postsurgery HRQoL according to the presence or absence of neoadjuvant treatments. METHODS: After diagnosis (T1) and after surgery (T2), 271 patients completed 3 questionnaires, assessing their intrapersonal and interpersonal EC, HRQoL, and anxiety and depressive symptoms. Patients were categorized into 2 groups: patients with only surgery (group 1) and patients who received neoadjuvant treatment in addition to surgery (group 2). Analyses were based on hierarchical regression analyses and the SPSS PROCESS Macro to test the indirect effect of EC on HRQoL through anxiety and depression. RESULTS: Results showed an increase in depressive symptoms and a decrease in both anxiety symptoms and HRQoL between diagnosis and surgery, regardless of neoadjuvant treatment. At T1 and T2, EC predicted fewer anxiety and depressive symptoms and a less impaired HRQoL in the surgery-only group (group 1). Emotional competence, particularly intrapersonal EC, showed a significant indirect effect on HRQoL after surgery via fewer depressive symptoms. CONCLUSION: Emotional competence promotes fewer anxiety and depressive symptoms and less impaired HRQoL after diagnosis and after surgery, especially for patients without neoadjuvant treatments. IMPLICATIONS FOR PRACTICE: It is important for oncology nurses and other clinicians to consider the role of emotional processes in postsurgical HRQoL in relation to the type of received treatments and to reinforce the use of EC by cancer patients to improve their adjustment.

Creating scripted video-vignettes in an experimental study on two empathic processes in oncology: Reflections on our experience.

OBJECTIVE: The aims were to: (1) apply the guidelines to develop and test the validity of video-vignettes manipulating empathy and context in oncology; (2) compare lay people's and patients' assessments of validity; (3) reflecting on our experiment METHODS: Guidelines were followed: (1) deciding whether video-vignettes were appropriate; (2) developing a valid script; (3) designing valid manipulations; (4) converting the scripted consultations into videos. One hundred sixteen lay people and 46 cancer patients filled in the Video Engagement Scale, the CARE, and ad hoc questionnaires on realism and emotions. RESULTS: The video-vignettes are valid for experimental use. Differences appeared in the emotions participants reported. The empathic processes were successfully manipulated and perceived. Lay people's and patients' assessments were equivalent, except for video-vignettes in neutral consultations. Participants' comments on nonverbal behavior, camera perspective, scripts and empathy assessment were reported. CONCLUSION: Patients' assessments are impacted by their personal experiences. Researchers should control for this in analogue patient studies. PRACTICE IMPLICATIONS: Based on this experience, we reflect on: (1) adopting congruent nonverbal behavior throughout the video-vignettes; (2) alternating camera perspectives; (3) avoiding the sole use of written scripts; (4) using quantitative and qualitative analysis to validate scripts and video-vignettes.

Testing two competitive models of empathic communication in cancer care encounters: A factorial analysis of the CARE measure.

OBJECTIVE: The mechanisms associating physician empathy (PE) with patient outcomes remain unclear. PE can be considered as a whole (one process) or three subcomponents can be identified (an establishing rapport process; an emotional process; a cognitive process). The objective was to test two competitive models of PE in cancer care: a three-process model adapted from Neumann's model versus a one-process model, with the use of the Consultation and Relational Empathy measure (CARE). METHODS: The CARE was completed by 488 oesogastric cancer patients from the national French database FREGAT. A confirmatory factor analysis (CFA) and a bifactor model were performed to test the two competitive models. RESULTS: The CFA revealed that the one-factor structure showed a moderate fit to the data whereas the three-factor structure showed a good fit. However, the bifactor model favoured unidimensionality. CONCLUSION: We cannot provide a clear-cut conclusion about whether PE should be considered as on unique process or not. Further work is still needed. Meanwhile, one should not preclude the use of three subscores in cancer care if specific elements of the encounter need to be assessed.

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.