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Blot F, Fasse L, Mateus C, Renard P, Verotte N, de Jesus A, Dumont SN. [Implementation of a multimodal strategy for information and collection of advance directives in a comprehensive cancer center]. Bull Cancer 2023:S0007-4551(23)00133-9. [PMID: 36963998 DOI: 10.1016/j.bulcan.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION In France, advance directives (AD) remain unknown and underused by healthcare users and professionals. This is particularly true in oncology. This work was carried out with patients and caregivers of a Comprehensive Cancer Center to improve their appropriation and information. METHODS The project, built by the Ethics Committee, the Patients Committee and the Palliative Care Team, made it possible to develop over 6 months a training program, an information procedure and several original documents. RESULTS A total of 34 one-hour training courses for all professionals were organized. A procedure for making information available, including the right to draft ADs, has been implemented. This procedure is personalized, gradual and multi-professional. When a patient wishes to write his AD, he is accompanied by a dedicated team and benefits from a specific form, which enlighten values and preferences before addressing the desired level of therapeutic commitment. Communication elements were diffused, and a specific training on "anticipated discussions" was created. A dedicated space in the computerized chart makes it possible to locate the existence of ADs and to display them instantaneously. DISCUSSION - CONCLUSION: Based on the observation of the obstacles to the use of ADs, the strategy we implemented aims to provide information that is both efficient and ethically respectful for both patients and caregivers. ADs are only one element facilitating autonomy and anticipation, and must be associated with a shared continuous definition of the project and of the goals of care.
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Affiliation(s)
- François Blot
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Réanimation, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France.
| | - Léonor Fasse
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Unité de psycho-oncologie, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Christine Mateus
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Équipe mobile de soins palliatifs, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Perrine Renard
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Équipe mobile de soins palliatifs, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Nelly Verotte
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Direction des affaires juridiques, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Anne de Jesus
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Direction de la qualité, relation avec les usagers, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Sarah N Dumont
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Département de médecine oncologique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
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Validity of the French version of the Autonomy Preference Index and its adaptation for patients with advanced cancer. PLoS One 2020; 15:e0227802. [PMID: 31935263 PMCID: PMC6959662 DOI: 10.1371/journal.pone.0227802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/31/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND While patient-centered care is recommended as a key dimension for quality improvement, in case of serious illness, patients may have different expectations regarding information and participation in medical decision-making. In oncology, anticipation of disease worsening remains difficult, especially when patient's preferences towards prognosis medical information are unclear. Valid tools to explore patients' preferences could help targeting end-of-life discussions, which have been shown to decrease aggressiveness of end-of-life care. Our aim was to establish the validity and reliability of the French version of the Autonomy Preference Index (API) among patients with incurable cancer and in primary care setting. Three supplementary items were specifically developed to evaluate preparedness to anticipate disease deterioration among patients with incurable cancer. METHODS The psychometric properties of the API translated into French were assessed among patients consecutively recruited from January to March 2017 in the waiting rooms of 19 general practitioners (N = 391) and in an oncology (N = 187) clinic in Paris. Relationships between the newly-developed items and the API subscale scores were studied. RESULTS A three correlated factors confirmatory model (two factors related to decision-making and a factor related to information-seeking preferences) showed an acceptable fit on the whole sample and no measurement invariance issue was found across settings, age, sex and educational level. Internal consistency and test-retest reliability were acceptable for the information-seeking and decision-making subscales. One of the newly-developed items on patients' ability to anticipate a decision on the use of artificial respiration if a sudden deterioration of their illness occurred was not related to the API subscale scores. CONCLUSION The French version of the API was found valid and reliable for use in general practice and oncology settings. The additional items on patient preparedness to anticipate disease deterioration can be of interest to ensure that patient values guide all end-of-life clinical decisions.
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Martinez-Tapia C, Canoui-Poitrine F, Caillet P, Bastuji-Garin S, Tournigand C, Assaf E, Varnier G, Pamoukdjian F, Brain E, Rollot-Trad F, Laurent M, Paillaud E. Preferences for surrogate designation and decision-making process in older versus younger adults with cancer: A comparative cross-sectional study. PATIENT EDUCATION AND COUNSELING 2019; 102:429-435. [PMID: 30293935 DOI: 10.1016/j.pec.2018.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the preferences of older (≥70 years old) versus younger (<70 years old) cancer patients regarding surrogate designation and decision making. METHODS A cross-sectional survey. Patient characteristics and information about surrogacy and involvement in decision making were collected. Associations between patient characteristics and preferences were examined. RESULTS The study included 130 patients aged ≥70 years (mean age 80 years) and 102 patients aged <70 years (mean age 55) and. Factors independently associated with surrogate knowledge (66%): younger age, more children living nearby, high income; factors associated with having already designated a surrogate (62%): younger age, decreased number of daily medications; factors associated with designating a surrogate after questionnaire administration (40%): low education, metastasis. Patients requiring an informed consent for any intervention was associated with older age (adjusted OR [aOR]per year = 1.04[95% confidence interval 1.00-1.08]), not living alone (aOR = 2.52[1.00-6.36]), and having children (aOR = 4.49[1.13-17.81]). CONCLUSION All cancer patients, wanted to be fully informed and 72% wanted to be involved in medical decisions. Preferences for decision control vary between age groups, depending on family members' presence and living alone. PRACTICE IMPLICATIONS Sharing complete and clear information should be an important key in the process of cancer patients' care, regardless of patient age.
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Affiliation(s)
- Claudia Martinez-Tapia
- Paris-Est University, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France.
| | - Florence Canoui-Poitrine
- Paris-Est University, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France; Assistance Publique Hôpitaux de Paris (AP-HP), Henri-Mondor Hospital, Public Health Department, Créteil, France
| | - Philippe Caillet
- Paris-Est University, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Henri-Mondor Hospital, Internal Medicine and Geriatric Department, Paris- Sud-Val-de-Marne Geriatric Oncology Clinic, Créteil, France; AP-HP, Georges-Pompidou European Hospital (HEGP), Geriatric Department, Paris, France
| | - Sylvie Bastuji-Garin
- Paris-Est University, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France; Assistance Publique Hôpitaux de Paris (AP-HP), Henri-Mondor Hospital, Public Health Department, Créteil, France; AP-HP, Henri-Mondor Hospital, Clinical Research Unit (URC Mondor), Créteil, France
| | - Christophe Tournigand
- AP-HP, Henri-Mondor Hospital, Department of Medical Oncology, Créteil, France; Paris-Est University, UPEC, EC2M3 Unit, VIC DHU, Créteil, France
| | - Elias Assaf
- AP-HP, Henri-Mondor Hospital, Department of Medical Oncology, Créteil, France
| | - Gwénaëlle Varnier
- AP-HP, Henri-Mondor Hospital, Internal Medicine and Geriatric Department, Paris- Sud-Val-de-Marne Geriatric Oncology Clinic, Créteil, France
| | - Frederic Pamoukdjian
- APHP, Avicenne Hospital, Geriatric department, Coordination Unit in Geriatric Oncology, Bobigny, France; Paris 13 University, Sorbonne Paris Cité, Health Education and Practices Laboratory, (LEPS EA3412), Bobigny, France
| | - Etienne Brain
- Institut Curie (Hôpital René Huguenin), Department of Medical Oncology, St Cloud, France
| | - Florence Rollot-Trad
- Institut Curie Hospital, Geriatric oncology and supportive care department, Paris, France
| | - Marie Laurent
- Paris-Est University, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Henri-Mondor Hospital, Internal Medicine and Geriatric Department, Paris- Sud-Val-de-Marne Geriatric Oncology Clinic, Créteil, France
| | - Elena Paillaud
- Paris-Est University, UPEC, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Henri-Mondor Hospital, Internal Medicine and Geriatric Department, Paris- Sud-Val-de-Marne Geriatric Oncology Clinic, Créteil, France; AP-HP, Georges-Pompidou European Hospital (HEGP), Geriatric Department, Paris, France
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Razafimbelo H, Laloui K, Lassouane S, Ribemont AC, Rabus MT, Rwabihama JP. [Physicians and advance directives in geriatric setting]. SOINS. GERONTOLOGIE 2018; 23:34-39. [PMID: 30522762 DOI: 10.1016/j.sger.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Advance directives (AD) are not sufficiently applied in geriatric setting despite their widespread dissemination since the publication of Claeys-Leonetti law. The aim of this study was to analyze geriatricians' knowledge of the concept of AD and to evaluate their practices in the process of patient information and AD collection.
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Affiliation(s)
- Hoby Razafimbelo
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Pôle gériatrique de l'Essonne, Site Dupuytren, 1 avenue Eugène-Delacroix, 91210 Draveil, France
| | - Kenza Laloui
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Pôle gériatrique de l'Essonne, Site Dupuytren, 1 avenue Eugène-Delacroix, 91210 Draveil, France
| | - Sadia Lassouane
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Pôle gériatrique de l'Essonne, Site Dupuytren, 1 avenue Eugène-Delacroix, 91210 Draveil, France
| | - Annie-Claude Ribemont
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Pôle gériatrique de l'Essonne, Site Dupuytren, 1 avenue Eugène-Delacroix, 91210 Draveil, France
| | - Marie-Thérèse Rabus
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Pôle gériatrique de l'Essonne, Site Dupuytren, 1 avenue Eugène-Delacroix, 91210 Draveil, France
| | - Jean-Paul Rwabihama
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Pôle gériatrique de l'Essonne, Site Dupuytren, 1 avenue Eugène-Delacroix, 91210 Draveil, France; Université Paris-Est Créteil, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing), 51 avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France.
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Goldwasser F, Nisenbaum N, Vinant P, Balladur E, Dauchy S, Farota-Romejko I, Colombet I, Alby ML, Giroux J, Larrouy A, Destaintot E, Garcon L, Legrand D, Marin I. La réunion de concertation pluridisciplinaire onco-palliative : objectifs et préconisations pratiques. Bull Cancer 2018; 105:458-464. [DOI: 10.1016/j.bulcan.2018.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/13/2018] [Accepted: 01/29/2018] [Indexed: 12/25/2022]
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Advance directives from haematology departments: the patient's freedom of choice and communication with families. A qualitative analysis of 35 written documents. BMC Palliat Care 2018; 17:10. [PMID: 29291716 PMCID: PMC5749003 DOI: 10.1186/s12904-017-0265-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 12/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In France, advance directives are favourably perceived by most of the population, although the drafting rate is low. This ambivalence is challenging because advance directives are meant to promote the autonomy and freedom of choice of patients. The purpose of this study was to analyse the content of advance directives written by patients suffering from malignant haemopathies to better understand how patients put them into practice. These could be relevant as early as the initial diagnosis of haematological malignancies because of the uncertain course of the disease. METHODS This was a multicentre, qualitative, descriptive study. The advance directives written by patients with malignant haemopathies treated in one of the six French hospital departments were included in the study from 01/06/2008 to 15/04/2016. A thematic analysis of the advance directives was performed by two researchers: a senior haematologist and a research assistant. RESULTS The median age of the patients was 69. Most were women (sex ratio: 0.59), living as a couple (57%), with lymphoid pathologies (66%), who were still alive two years after the instructions were written (63%) and had nominated a health care proxy (88.6%). Free texts (62.9%) were richer in content than pre-defined forms. The advance directives were used in three ways: for a purely legal purpose, to focus on medical treatments or actions, or to communicate a message to the family. Three main themes emerged: (1) refusal of medical treatment (100%), in which patients express refusal of life-sustaining care (97.1%). The actual treatments or the moment when they should be limited or stopped were not always mentioned in detail. (2) A desire for effective pain relief to avoid suffering (57.1%) and (3) messages for their family (34.3%), such as funeral arrangements (17.1%) and messages of love or trust (14.3%). CONCLUSIONS Patients who write advance directives are not necessarily at the end of their lives. Their content mainly conveys treatment wishes, although patients also use them to pass on personal messages to their close family. This emerging role of advance directives to communicate messages within the family should be valued, even if it is not their original purpose.
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[Why and how to promote decision-making autonomy of cancer patients?]. Bull Cancer 2017; 105:193-199. [PMID: 29128081 DOI: 10.1016/j.bulcan.2017.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 01/22/2023]
Abstract
Involvement of patients in decision-making about their health has been promoted nationally and internationally since several years. Despite this, patient (and their relatives) participation remains insufficient and one of the objectives of the current French national cancer policy (Plan cancer 2014-2019) is to give everyone the possibility to play an active role in the management of their care. This overview focuses on decision-making autonomy of cancer patients through two main questions: why and how to promote it? After a brief review of the decision-making models described in the literature in the past decades insisting on the major role of the decisional context and the dynamic character of this context, this article presents a selection of published works which aimed to respond to those 2 questions.
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Sanson H, Priollet P. [Can the vascular specialist improve patient awareness about advanced directives?]. JOURNAL DES MALADIES VASCULAIRES 2016; 41:161-8. [PMID: 27102851 DOI: 10.1016/j.jmv.2016.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In France, the Leonetti law, adopted on April 22, 2005, stipulates the regulations concerning advanced directives. This is a patient's right that is not well known and rarely applied. In 2015, a new law project was thus presented in which the French National Authority for Health recommended that doctors, including all specialists, bring up the subject, especially during consultation. OBJECTIVES To evaluate the vascular specialist's possibility to mention the topic of advanced directives during consultations. METHOD A single and non-interventional prospective study conducted with the help of patients who consulted a private practitioner vascular specialist: recurrent patients regularly consulting a private practitioner vascular specialist were included. First-time consultants, minors and patients to whom it was not adapted to speak about the subject were not included. RESULTS Between July 27 and September 23, 2015, 159 consecutive patients were examined. Fifty-five first-time consultants and four patients for whom the interview was unsuitable were excluded. In all, 100 patients were questioned. None of them refused to talk about the subject. Women made up a majority of the population (63 %) with an average age of 67 years (23-97). The principal diagnostics were common to vascular medicine consultations: deep vein thrombosis (20 %), peripheral arterial disease (15 %), varicose veins (11 %), lymphedema (11 %) and leg ulcers (9 %). Thirteen percent of the people had a history of cancer. Half of the patients had had follow-ups for over 10 years. The average time devoted to discussing the topic was 12minutes (5-40). Only 22 % of the patients declared having been familiar with advance directives. Once informed however, 78 % chose to write up an adapted form: 36 % with the help of their doctor and 42 % with a doctor and a relative. Seventy-three percent of the consultants thought that talking about the advance directives would reinforce the confidence link between the doctor and the patient. CONCLUSION In private practice vascular medicine, it seems possible to mention the subject of advance directives, as recommended by the French authorities. The procedure is well perceived by the patients. It nevertheless implies allotting a non-negligible amount of additional consultation time. The reinforcement of the doctor-patient relationship suggested by these results should be confirmed by a qualitative study made up of meetings.
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Affiliation(s)
- H Sanson
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - P Priollet
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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Velter C, Cribier B, Goldwasser F, Vinant P. [Advance directives in dermato-oncology: The current situation and future prospects]. Ann Dermatol Venereol 2016; 143:505-11. [PMID: 27080821 DOI: 10.1016/j.annder.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/26/2015] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Patient information and advance directives (AD) are described in the French laws of 4 March 2002 and 22 April 2005, which concern the decisions of subjects regarding end-of-life treatment. At present, practitioners rarely seek the opinion of patients on this matter. The Claeys-Leonetti law requires doctors to identify any advance directives by patients, which are binding upon medical staff. The present study sought to analyse the extent of application of the laws of 2002 and 2005 and to collect the observations of clinicians in dermato-oncology regarding the new legislation. METHODS We contacted members of the French dermato-oncology group by email and asked them to assess their practices with regard to information provision, patient surrogates and advance directives. RESULTS To 111 requests we received 34 replies from hospital dermatologists, i.e. a response rate of 31 %. In all, 85 % of clinicians informed patients with metastasis that their disease was incurable, and 94 % stated that they have procedures in place concerning the appointment of a patient surrogate. One third of respondents reported having a procedure in place for provision of information or collection of advance directives. According to 91 % of clinicians, the binding nature of advance directives did not constitute any loss of chance for the patient in question; 59 % felt that the new law would affect their practices, but of these, paradoxically, 60 % felt that this would have no impact on their therapeutic decision-making. In all, 26 clinicians (76.5 %) did not intend to modify their decision-making process. CONCLUSION The law of 2002 is generally better known than that of 2005. Dermato-oncologists are not aware of the practical consequences of the new binding nature of advance directives with regard to the doctor-patient relationship and the actual decision-making process.
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Affiliation(s)
- C Velter
- Clinique dermatologique, faculté de médecine, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France; Laboratoire d'éthique médicale, université Paris Descartes, 45, rue des Saints-Pères, 75006 Paris, France.
| | - B Cribier
- Clinique dermatologique, faculté de médecine, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - F Goldwasser
- Service de cancérologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris (AP-HP), 123, boulevard de Port-Royal, 75014 Paris, France
| | - P Vinant
- Service de médecine palliative, hôpital Cochin, université Paris Descartes, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France
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