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Charmasson A, Ecollan M, Jaury P, Partouche H, Frachon A, Pinot J. Perceived impact of discussions with a healthcare professional on patients' decision regarding COVID-19 vaccine. Hum Vaccin Immunother 2024; 20:2307735. [PMID: 38346925 PMCID: PMC10863372 DOI: 10.1080/21645515.2024.2307735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
There is evidence that advice from Healthcare Professionals (HCPs) plays an important role in patients' decision to get vaccinated, but the extent to which patients perceive this impact is unclear. The aim of this study was to assess the perceived impact of a discussion with a HCP on participants' decision to be vaccinated against COVID-19. A cross-sectional survey was conducted among adults who consulted a general practitioner (GP) or a pharmacist in Ile-de-France, France, after COVID-19 vaccines became available (October-November 2021 period). A total of 344 participants were included, 65.2% of whom reported having had a discussion about COVID-19 vaccines with a HCP. Overall, 55% of participants were advised to be vaccinated by their HCP. Most of the discussions took place with a GP (n = 203, 48.9%). According to 52.5% of participants, the discussion had a positive impact, i.e. it was perceived as encouraging vaccination. The latter reported that, among HCPs, GPs had the greatest number of discussions with a positive impact on the decision to be vaccinated against COVID-19 (93.1%). In the study population, the COVID-19 vaccine hesitancy rate, according to the WHO definition, was high (38.1%), although the COVID-19 vaccine coverage rate was 87.1%. Vaccine hesitant participants were more likely to report a discussion that had a perceived negative impact on their decision to get vaccinated (20.0%) than non-hesitant participants (5.8%, p = .004).
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Affiliation(s)
- Alric Charmasson
- Department of General Practice, Université Paris Cité, Paris, France
| | - Marie Ecollan
- Department of General Practice, Université Paris Cité, Paris, France
| | - Philippe Jaury
- Department of General Practice, Université Paris Cité, Paris, France
| | - Henri Partouche
- Department of General Practice, Université Paris Cité, Paris, France
| | - Adèle Frachon
- Department of General Practice, Université Paris Cité, Paris, France
| | - Juliette Pinot
- Department of General Practice, Université Paris Cité, Paris, France
- INSERM, IAME, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
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Abstract
BACKGROUND SARS-CoV-2 has been responsible for a pandemic since the beginning of 2020. Vaccine arrival brings a concrete solution to fight the virus. However, vaccine hesitancy is high. In France, the first available vaccine was Comirnaty from Pfizer-BioNTech. Shared decision-making, based on tools such as patient decision aids (PtDAs), can help patients make an informed choice about vaccination with Comirnaty. OBJECTIVE The French College of Teachers in General Practice (CNGE) aimed to create a PtDA for people who have to decide whether they will receive the Comirnaty vaccine. METHODS Development of the PtDA was performed according to the International Patient Decision Aids Standards (IPDAS). The initial design was based on a literature review and semistructured interviews with 17 patients to explore and clarify patients' expectations. A first draft of the PtDA was then alpha tested by a patient expert group and a physician expert group. The PtDA was finally beta tested in 14 prevaccine consultations. A steering group was consulted throughout the work. Patient support, community groups and the French National Authority for Health (HAS) were involved in the development process. RESULTS A literature review identified one randomized trial on Comirnaty efficacy and safety. The first part of the PtDA allows patients to identify their own risk factors. The second part of the PtDA provides information on vaccination: benefits and risks, unknown data, and technical explanations about the mRNA vaccine. CONCLUSIONS We developed a PtDA to be used in primary care settings for shared decision-making regarding vaccination with Comirnaty.
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Affiliation(s)
- Yves-Marie Vincent
- Department of General Practice, Université de Bordeaux, Bordeaux, France
- French National College of Teachers in General Practice, Paris, France
| | - Adèle Frachon
- Département de médecine générale, Université de Paris, Faculté de Santé, UFR de Médecine, F-75014 Paris, France
| | | | - Remy Boussageon
- French National College of Teachers in General Practice, Paris, France
- University College of General Medicine, Université Claude Bernard Lyon 1, Lyon, France
- UMR 5558, Laboratory of Biometry and Evolutionary Biology, Centre National de la Recherche Scientifique, Lyon, France
| | - Denis Pouchain
- French National College of Teachers in General Practice, Paris, France
| | - Emilie Ferrat
- French National College of Teachers in General Practice, Paris, France
- Primary Care Department, Faculty of Medicine, University of Paris-East Creteil, Creteil, France
- Clinical Epidemiology and Ageing Unit, University of Paris-Est Creteil, Creteil, France
| | - Cédric Rat
- French National College of Teachers in General Practice, Paris, France
- Department of General Practice, University of Nantes, Nantes, France
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Durand MA, Lamouroux A, Redmond NM, Rotily M, Bourmaud A, Schott AM, Auger-Aubin I, Frachon A, Exbrayat C, Balamou C, Gimenez L, Grosclaude P, Moumjid N, Haesebaert J, Massy HD, Bardes J, Touzani R, Diant LBEF, Casanova C, Seitz JF, Mancini J, Delpierre C. Impact of a health literacy intervention combining general practitioner training and a consumer facing intervention to improve colorectal cancer screening in underserved areas: protocol for a multicentric cluster randomized controlled trial. BMC Public Health 2021; 21:1684. [PMID: 34530800 PMCID: PMC8444501 DOI: 10.1186/s12889-021-11565-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of cancer burden worldwide. In France, it is the second most common cause of cancer death after lung cancer. Systematic uptake of CRC screening can improve survival rates. However, people with limited health literacy (HL) and lower socioeconomic position rarely participate. Our aim is to assess the impact of an intervention combining HL and CRC screening training for general practitioners (GPs) with a pictorial brochure and video targeting eligible patients, to increase CRC screening and other secondary outcomes, after 1 year, in several underserved geographic areas in France. METHODS We will use a two-arm multicentric randomized controlled cluster trial with 32 GPs primarily serving underserved populations across four regions in France with 1024 patients recruited. GPs practicing in underserved areas (identified using the European Deprivation Index) will be block-randomized to: 1) a combined intervention (HL and CRC training + brochure and video for eligible patients), or 2) usual care. Patients will be included if they are between 50 and 74 years old, eligible for CRC screening, and present to recruited GPs. The primary outcome is CRC screening uptake after 1 year. Secondary outcomes include increasing knowledge and patient activation. After trial recruitment, we will conduct semi-structured interviews with up to 24 GPs (up to 8 in each region) and up to 48 patients (6 to 12 per region) based on data saturation. We will explore strategies that promote the intervention's sustained use and rapid implementation using Normalization Process Theory. We will follow a community-based participatory research approach throughout the trial. For the analyses, we will adopt a regression framework for all quantitative data. We will also use exploratory mediation analyses. We will analyze all qualitative data using a framework analysis guided by Normalization Process Theory. DISCUSSION Limited HL and its impact on the general population is a growing public health and policy challenge worldwide. It has received limited attention in France. A combined HL intervention could reduce disparities in CRC screening, increase screening rates among the most vulnerable populations, and increase knowledge and activation (beneficial in the context of repeated screening). TRIAL REGISTRATION Registry: ClinicalTrials.gov. TRIAL REGISTRATION NUMBER 2020-A01687-32 . Date of registration: 17th November 2020.
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Affiliation(s)
- Marie-Anne Durand
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.,Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
| | - Aurore Lamouroux
- Assistance Publique - Hôpitaux de Marseille, Marseille, France.,Comité Départemental d'Éducation pour la Santé de Vaucluse (CoDES 84), Avignon, France
| | - Niamh M Redmond
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.
| | - Michel Rotily
- Assistance Publique - Hôpitaux de Marseille, Marseille, France.,EA 3279: Aix-Marseille Université, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | | | | | | | - Adèle Frachon
- Département de Médecine Générale, Université de Paris, Paris, France
| | - Catherine Exbrayat
- Centre Régional de Coordination du Dépistage des Cancers (CRCDC-AuRA), Auvergne-Rhônes-Alpes, Saint Étienne, Cedex 02, France
| | - Christian Balamou
- Centre Régional de Coordination du Dépistage des Cancers (CRCDC-AuRA), Auvergne-Rhônes-Alpes, Saint Étienne, Cedex 02, France
| | - Laëtitia Gimenez
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.,Faculté de Médecine - Département Universitaire de Médecine Générale, Toulouse, France
| | - Pascale Grosclaude
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.,Institut Claudius Regaud, IUCT-O, Registre des cancers du Tarn, Toulouse, F-31059, France
| | - Nora Moumjid
- P2S EA4129, Centre Léon Bérard, Université Lyon 1, Lyon, France
| | | | - Helene Delattre Massy
- Centre Régional de Coordination du Dépistage des Cancers d'Ile de France (CRCDC-IDF), Paris, France
| | - Julia Bardes
- Centre Régional de Coordination du Dépistage des Cancers d'Ile de France (CRCDC-IDF), Paris, France
| | - Rajae Touzani
- Institut Paoli Calmettes, SESSTIM UMR1252, Marseille, France.,Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" group, Hôpital Timone, Marseille, France
| | | | - Clémence Casanova
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" group, Hôpital Timone, Marseille, France
| | - Jean François Seitz
- Service d'Hépato-Gastroentérologie, Hôpital Timone, Assistance Publique Hôpitaux Marseille & Aix-Marseille-Université, Marseille, France.,Centre Régional de Coordination du Dépistage des Cancers Provence-Alpes-Côte d'Azur (CRCDC-PACA), Marseille, France
| | - Julien Mancini
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" group, Hôpital Timone, Marseille, France
| | - Cyrille Delpierre
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France
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Vincent YM, Frachon A, Buffeteau C, Conort G. Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care. BMC Fam Pract 2021; 22:26. [PMID: 33499824 PMCID: PMC7839208 DOI: 10.1186/s12875-021-01374-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
Background Uncomplicated urinary tract infection (uUTI) is very common among women in primary care. The risk of developing pyelonephritis remains low after uUTI, nonetheless, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This may lead to adverse effects and antibiotic resistance. Furthermore, patients may express the will to limit the use of antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of this study is to create a patient decision aid (PtDA) used in primary care settings to make a shared decision between practitioners and women about whether or not to treat uUTI with antibiotics. Methods We followed the steps recommended by the International Patient Decision Aids Standards, with a scoping phase, a design phase (including focus groups and literature review), and an alpha-testing phase. A steering group, made of patients and physicians, met throughout the study to develop a prototype PtDA. Results The information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks, and consequences, based on a review of the literature. The results of the focus group made possible to determine the patient’s values and preferences to consider in decision-making, including: the discomfort felt, the impact on daily life, patients’ perceptions of antibiotics, and the position relative to the risk of adverse effect. The choices in presentation, organisation and design are the result of the work of the steering group, improved by feedback from alpha testing. We confirmed the need for shared decision-making and the equipoise in this situation. Conclusions We developed a PtDA to be used in primary care for sharing decision on the use of antibiotic in uUTI. It needs to be validated in a beta-testing phase, with complementary advice from peers, and then tested in a clinical study comparing its use with the systematic prescription approach.
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Affiliation(s)
- Yves-Marie Vincent
- Département de Médecine Générale, Université de Bordeaux, Collège Sciences de la santé, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.
| | - Adèle Frachon
- Département de Médecine Générale, Université de Bordeaux, Collège Sciences de la santé, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France
| | - Clotilde Buffeteau
- Département de Médecine Générale, Université de Bordeaux, Collège Sciences de la santé, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France
| | - Guillaume Conort
- Département de Médecine Générale, Université de Bordeaux, Collège Sciences de la santé, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France
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Frachon A, Vignier N. [Health issues in precarious people]. Rev Prat 2020; 70:385-391. [PMID: 32877090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Health issues in precarious people. Though if it is not possible to draw a single picture of the health of precarious people, many works on social inequalities in health underline their vulnerability and an increased frequency of a variety health problems. We can cite certain harmful behaviors for health (smoking, consumption of psychoactive substances, insufficient food or, conversely, too rich and not very diversified, sedentary lifestyle, delay in screening and prevention, violence, etc...), for certain diseases (cardiovascular diseases, skin diseases, dental problems, respiratory diseases, mental distress, infectious diseases including tuberculosis and HIV, etc.) and in terms of access to care and prevention. Thus, despite the resources to reduce social inequalities in health in France, the state of health of people in precarious situations continues to deteriorate and should constitute a public health priority for health authorities and for caregivers.
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Affiliation(s)
- Adèle Frachon
- Équipe de recherche en épidémiologie sociale, Inserm, Sorbonne Université, IPLESP, UMR 1136, Institut Convergences Migrations, Paris, France
- Département de médecine générale, Université de Bordeaux
| | - Nicolas Vignier
- Équipe de recherche en épidémiologie sociale, Inserm, Sorbonne Université, IPLESP, UMR 1136, Institut Convergences Migrations, Paris, France
- Service des maladies infectieuses et tropicales et PASS, groupe hospitalier Sud-Île de France, IPLESP, Sorbonne Université, UMRS-1136, Paris, France
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