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Terrasson J, Rault A, Seigneur É, Brédart A, Dolbeault S. [The announcement of treatment resistance in pediatric oncology: Understanding parents' experiences and influencing factors with a mixed methodology]. Bull Cancer 2023:S0007-4551(23)00160-1. [PMID: 37100684 DOI: 10.1016/j.bulcan.2023.03.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/24/2023] [Accepted: 03/17/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE The announcement of a resistance to treatment in pediatric oncology occurs within the framework of an established parent-pediatrician relationship. The aim of this study was to understand the parents' experience of this announcement and the relational and communicational factors likely to impact it. METHOD A mixed-methods study was conducted in a pediatric oncology department with 15 parents of a child with treatment-resistant cancer, with an average age of 40.8years. The parents completed three questionnaires to assess their anxiety and depression (HADS) and their information needs (EORTC - QLQ Info 25 and PTPQ). Semi-structured interviews were conducted and a content analysis was performed. RESULTS The majority of parents have "suspected" or "proven" anxiety and/or depressive disorders. The experience of this announcement was influenced by the quality of the parent-pediatrician relationship, the perceived quality of the management, the anticipation of the announcement, the context of the announcement, and the experience of previous announcements. The parents interviewed were very satisfied with the informational exchanges. This satisfaction was underpinned by honest communication and by the responsiveness and availability of the pediatricians. DISCUSSION The establishment of a relationship of trust between the family and the pediatrician throughout the course of care plays a major role in the parents' experience of the announcement of resistance to treatment.
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Affiliation(s)
- Johanna Terrasson
- PSL université Paris, équipe SHARE Institut Curie, unité de psycho-oncologie, 75005 Paris, France.
| | - Aude Rault
- PSL université Paris, équipe SHARE Institut Curie, unité de psycho-oncologie, 75005 Paris, France
| | - Étienne Seigneur
- PSL université Paris, équipe SHARE Institut Curie, unité de psycho-oncologie, 75005 Paris, France; Institut Curie, centre SIREDO - Soins Innovation, Recherche en oncologie de l'Enfant, de l'aDOlescent et de l'adulte jeune, 75005 Paris, France
| | - Anne Brédart
- PSL université Paris, équipe SHARE Institut Curie, unité de psycho-oncologie, 75005 Paris, France; Université de Paris, laboratoire psychopathologie et processus de santé, 92100 Boulogne-Billancourt, France
| | - Sylvie Dolbeault
- PSL université Paris, équipe SHARE Institut Curie, unité de psycho-oncologie, 75005 Paris, France; University Paris Saclay, Inserm, Centre de recherche en épidémiologie et santé des populations (CESP), 94807 Villejuif, France
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Terrasson J, Rault A, Seigneur É, El Mellah L, Dolbeault S, Brédart A. How do you tell parents whose child has cancer that the treatment has failed: A qualitative study on pediatric oncologists' practices. Pediatr Hematol Oncol 2022; 40:382-394. [PMID: 36094797 DOI: 10.1080/08880018.2022.2120936] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Announcing drug resistance is complex for pediatric oncologists because they have to provide a substantial amount of medical information while taking a major emotional impact on the parents into account. This study aimed to understand how these announcements are currently conducted and how pediatric oncologists adapt the information given to each family in situations where there is resistance to treatment. Semi-structured interviews were conducted with 15 pediatric oncologists (66.7% women, aged 44.7 years on average). Interviews were audio-recorded and a thematic content analysis was conducted. Announcements of drug resistance are stressful, as they are not well codified, difficult to anticipate, and pediatric oncologists have many issues about how best to behave and which words to choose. The majority of them believe that the severity, or even the incurability of the disease, and the offer of a therapeutic alternative are essential components of the information to pass on. Pediatric oncologists describe how they adapt their communication to each family, particularly in relation to parents' questions, and also to their reactions during the announcement. They also need to adapt to the prior acquaintance they may have with the families, and to previous exchanges. Finally, pediatric oncologists acknowledge their subjectivity when estimating the parents need in terms of information. Understanding the course of these announcements gives us another point of view at the issues involved in this announcement. Proposals to support pediatric oncologists in this difficult moment can be suggested: communication support tool, work in pairs and discussion group.
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Affiliation(s)
- Johanna Terrasson
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Aude Rault
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Étienne Seigneur
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Institut Curie, SIREDO Oncology Center, Paris, France
| | - Leïla El Mellah
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Sylvie Dolbeault
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Research Center in Epidemiology and Health Population, INSERM, Paris-Saclay University, Villejuif, France
| | - Anne Brédart
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Psychopathology and Health Process Laboratory, University of Paris, Boulogne-Billancourt, France
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Terrasson J, Rault A, Seigneur É, Doz F, Dolbeault S, Brédart A. [Announcing treatment resistance in pediatric oncology: A qualitative study of nurses' experiences]. Bull Cancer 2022; 109:1154-1161. [PMID: 35985866 DOI: 10.1016/j.bulcan.2022.06.002] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The announcement of treatment resistance is a key moment in the management of children treated for cancer. Although nurses are present at various stages of this announcement, few studies have examined their role and experience. This study proposes to enhance understanding of the experience of nurses at this time of the pediatric cancer trajectory in France. METHOD A qualitative study was conducted in two pediatric oncology departments. Semi-structured research interviews were conducted with seven pediatric nurses (five women) with an average age of 36.9 years. RESULTS Nurses report not being systematically present during announcements of treatment resistance but being present with the families before and after these announcements. Nurses described their role at this point in the management process as multifaceted. The emotional burden associated with these announcements is significant: nurses must manage their own emotions when faced with the discovery of resistance to treatment, those of the families, and must often answer difficult questions about the prognosis or end of life. In this context, teamwork is an important support. DISCUSSION Better awareness and recognition of the role of nurses and the associated emotional burden would enable them to fully carry out their missions.
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Affiliation(s)
- Johanna Terrasson
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France.
| | - Aude Rault
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France
| | - Étienne Seigneur
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Institut Curie, centre SIREDO - soins, innovation, recherche, en oncologie de l'enfant, de l'adolescent et de l'adulte jeune, 75005 Paris, France
| | - François Doz
- Institut Curie, centre SIREDO - soins, innovation, recherche, en oncologie de l'enfant, de l'adolescent et de l'adulte jeune, 75005 Paris, France; Université de Paris, 12, rue de l'École de Médecine, 75006 Paris, France; Institut Curie, UMR 144 CNRS, 75005 Paris, France
| | - Sylvie Dolbeault
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Université Paris-Saclay, centre de recherche en épidémiologie et santé des populations (CESP), U1018, Inserm, 94807 Villejuif, France
| | - Anne Brédart
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Université de Paris, laboratoire psychopathologie et processus de santé, 92100 Boulogne-Billancourt, France
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Terrasson J, Rault A, Dolbeault S, Brédart A. Question prompt lists to improve communication between cancer patients and healthcare professionals. Curr Opin Oncol 2022; 34:265-269. [PMID: 35730518 DOI: 10.1097/cco.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This literature review sets out to summarize knowledge on the impact of question prompt lists (QPLs) on patient-physician communication in oncology and to provide an account of current research on the development, adaptation, and implementation of this type of communication tool. RECENT FINDINGS Provided with a QPL, patients seem to ask more questions, in particular on sensitive issues like those around the end-of-life period and they recall the information provided better. There is a need to adapt QPLs, taking account of divergences in attitudes towards illness, participation in decision-making, and discussions about the illness prognosis across cultures. QPLs may also need to be tailored to specific concerns of patients at the different stages in the care trajectory and to the particularities of each cancer type. These adaptations contribute to the effectiveness of the tool because they make it possible to tailor it to the challenges and constraints experienced in clinical practice. SUMMARY QPLs are designed to enhance patients' communication with their physicians. Further research is required to develop QPLs suited to each cultural and clinical setting, involving health professionals so as to facilitate the implementation of these tools in routine practice.
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Affiliation(s)
- Johanna Terrasson
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris
| | - Aude Rault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris.,CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif cedex, France
| | - Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris.,Paris University, Psychology Institute, Psychopathology and health process laboratory Boulogne-Billancourt
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Piperno-Neumann S, Rodrigues M, Marchal T, Gastaud L, Fogliarini A, Bouleuc C, Libert Y, de Koning L, Bredart A, Savignoni A, Dolbeault S, Burnod A. Early together: A randomized phase III study of early palliative care in metastatic uveal melanoma (MUM). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps9598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9598 Background: Uveal melanoma is a rare cancer. Up to 50% of patients (pts) develop metastasis, mainly hepatic. Overall survival in metastatic pts is 12 months (mo), contrasting with a good overall condition until death. To evaluate the impact of integrating early palliative care on patient needs and self-efficacy, we designed a comparative randomized trial in MUM pts. Methods: 162 pts will be randomized (1:2) between the control and the experimental groups in two French centres (Institut Curie-Paris and Centre Antoine Lacassagne-Nice). In the control group, palliative care is introduced according to international guidelines. In the experimental group, it is added earlier, concomitant to the announcement of metastases by the medical oncologist. The main objective is to assess if early supportive care impacts on patient psychological needs at 6 mo, versus standard of care, based on the SCNS-SF34 questionnaire. Secondary objectives include patient’s other needs at 6 and 12 mo, quality of life (QLQ-C30), progression-free and overall survival, and partners’ needs (SCNS-P&C). MUM pts, suitable for a treatment with no curative intent, ECOG PS 0-1, with no physical or biological sign of disease, and capable of filling questionnaires are eligible. Questionnaires are completed by all pts at each oncological visit (baseline, 3, 6, 9 and 12 mo). Supportive care visits take place every 6 weeks if needed and address patient’s information needs, disease and treatment understanding, social and psychological status, symptoms, and partners’ involvement. Prognostic uncertainty and disease seriousness in the absence of symptom is addressed depending on pts’ expressed needs. Medical oncologists and supportive care physicians from both centres attend communication skill training provided by an expert during the study. Analyses: SCNS-SF34 psychological needs scale scores at 6-mo will be compared with a Student’s t-test, in an ITT analysis. For 10 points mean score difference expected between groups (within standard deviation of 20 points) and a two-sided type 1 error of 5%, inclusion of 54 pts (control group) and 108 pts (experimental group) provides the study 85% of power. The planned inclusion period is 3 years, pts will be followed for one year, for a total study duration of 4 years. From July 2020 to January 2022, 63 pts have been enrolled in the trial; 2 pts declined. Five pts were removed early from the study: one for consent retrieval, 4 for early death due to metastasis. COVID-19 delayed enrollment for 5 months. We plan to complete the study Q4 2023 and to analyze the data Q4 2024. Clinical trial information: NCT04728113. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Carole Bouleuc
- Supportive Care Department, Institut Curie, Paris, France
| | - Yves Libert
- ULB Institut Jules Bordet, Brussels, Belgium
| | | | - Anne Bredart
- Psycho-oncology Department, institut Curie, Paris, France
| | | | | | - Alexis Burnod
- Supportive Care Department, Institut Curie, Paris, France
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Brédart A, De Pauw A, Tüchler A, Lakeman IMM, Anota A, Rhiem K, Schmutzler R, van Asperen CJ, Devilee P, Stoppa-Lyonnet D, Kop JL, Dolbeault S. Genetic clinicians' confidence in BOADICEA comprehensive breast cancer risk estimates and counselees' psychosocial outcomes: a prospective study. Clin Genet 2022; 102:30-39. [PMID: 35508697 PMCID: PMC9322298 DOI: 10.1111/cge.14147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/22/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022]
Abstract
Counseling for familial breast cancer focuses on communicating the gene test result (GENE) to counselees, but risk prediction models have become more complex by including non‐genetic risk factors (NGRF) and polygenic risk scores (PRS). We examined genetic clinicians' confidence in counseling and counselees' psychosocial outcomes, using the BOADICEA risk prediction tool with different categories of risk factors as input. A prospective observational study in Dutch, French and German genetic clinics was performed including 22 clinicians, and 406 of 460 (88.3%) eligible cancer‐unaffected women at high breast cancer risk assessed at pre‐test and 350 (76.1%) at post‐test. We performed multilevel analyses accounting for the clinician, and counselees' characteristics. Overall, risk estimates category by GENE versus GENE+ NGRF, or GENE+NGRF+PRS differed in 11% and 25% of counselees, respectively. In multilevel analyses, clinicians felt less confident in counseling when the full model provided lower breast cancer risks than GENE (i.e., in 8% of cases). Older counselees expressed higher breast cancer risk perception and worries about the hereditary predisposition when the full model provided higher breast cancer risks than GENE only. Genetic clinicians appear confident with breast cancer risk comprehensive models, which seem only to affect perceptions of older counselees.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, 26 rue d'Ulm, 75005 Paris Cedex 05, Paris, France.,University of Paris, 71 avenue Edouard Vaillant, Boulogne-Billancourt, France
| | - Antoine De Pauw
- Institut Curie, Cancer genetic clinic, PSL University, University of Paris, 26 rue d'Ulm, Paris Cedex 05, France
| | - Anja Tüchler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Hereditary Breast and Ovarian Cancer, Cologne, Germany, Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - Inge M M Lakeman
- Leiden University Medical Centre, Department of Clinical Genetics, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Amélie Anota
- Centre Léon Bérard, Department of Clinical Research and Innovation& Human and Social Sciences Department, 28 rue Laennec, 69373, Lyon; French National Platform Quality of Life and Cancer, Lyon, France
| | - Kerstin Rhiem
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Hereditary Breast and Ovarian Cancer, Cologne, Germany, Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - Rita Schmutzler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Hereditary Breast and Ovarian Cancer, Cologne, Germany, Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - C J van Asperen
- Leiden University Medical Centre, Department of Clinical Genetics, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Peter Devilee
- Leiden University Medical Centre, Department of Human Genetics, Department of Pathology, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Cancer genetic clinic, PSL University, University of Paris, 26 rue d'Ulm, Paris Cedex 05, France
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN, 3 place Godefroy de Bouillon, 54 015 Nancy Cedex, Nancy, France
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, 26 rue d'Ulm, 75005 Paris Cedex 05, Paris, France.,CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 avenue Paul Vaillant-Couturier, Villejuif cedex, France
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Dolbeault S, Terrasson J, Rault A, Malinowski D, Bisch AM, Soulié O, Brédart A. Interventions psycho-oncologiques : quelles approches innovantes ? Bull Cancer 2022; 109:548-556. [DOI: 10.1016/j.bulcan.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
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Brédart A, Kop JL, Tüchler A, De Pauw A, Cano A, Dick J, Rhiem K, Devilee P, Schmutzler R, Stoppa-Lyonnet D, Dolbeault S. Assessment of psychosocial difficulties by genetic clinicians and distress in women at high risk of breast cancer: a prospective study. Eur J Hum Genet 2022; 30:1067-1075. [PMID: 35399119 PMCID: PMC9437045 DOI: 10.1038/s41431-022-01096-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/03/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
We examined how often genetic clinicians correctly identify psychosocial difficulties in women at high breast cancer risk and explored effects of this assessment and the genetic test result on counselees’ distress. A prospective observational study of counselee–clinician dyads was performed in three French, German and Spanish genetic clinics, involving 709 counselees (participation rate, 83.4%) and 31 clinicians (participation rate, 100%). Counselee–clinician agreement in perceived psychosocial difficulties was measured after the pre-test genetic consultation. Multivariate mixed linear models accounting for clinicians were tested. Predicted distress levels were assessed after the pre- (T1) and post-test result disclosure consultations (T2). Depending on the difficulty domain, clinicians adequately assessed the presence or absence of difficulties in 51% (“familial issues”) to 59% (“emotions”) of counselees. When counselees’ and clinicians’ perceptions disagreed, difficulties were generally underestimated by clinicians. Counselees’ distress levels remained stable from T1 to T2, irrespective of clinicians’ appraisal adequacy, and the genetic test result disclosure. Psychological referral need were found in 20–42% of counselees, more frequently observed for difficulties in the “emotions” domain. Our findings suggest that the genetic test result is a suboptimal indicator for psychological referral. Instead, clinicians should focus on emotions expressed by counselees to appraise their needs for psychological support.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France. .,Psychopathology and Health Process Laboratory UR4057, Psychology Institute, Paris University, 71 Avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN, 3 Place Godefroy de Bouillon, 54015, Nancy Cedex, France
| | - Anja Tüchler
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Antoine De Pauw
- Institut Curie, Department of Genetics, INSERM U830, Paris University, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Alejandra Cano
- University Autónoma of Barcelona, Clinical and Health Psychology Department, Barcelona, Spain
| | - Julia Dick
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Peter Devilee
- Leiden University Medical Centre, Department of Human Genetics, Department of Pathology, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Department of Genetics, INSERM U830, Paris University, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France.,CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 Avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
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Terrasson J, Seigneur É, Rault A, El Mellah L, Dolbeault S, Brédart A. The announcement of treatment resistance from the pediatric oncologist's point of view: a qualitative study. Pediatr Hematol Oncol 2022; 39:132-144. [PMID: 34392770 DOI: 10.1080/08880018.2021.1956030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Breaking bad news in pediatric oncology covers widely diverse clinical situations. The aim of this study was to highlight the specificities of the announcement of treatment resistance as perceived by pediatric oncologists, particularly in comparison with the disclosure of a cancer diagnosis. Semi-structured interviews were conducted in two pediatric oncology departments in France, with 15 pediatric oncologists (66.7% were women, aged 44.7 years on average). Interviews were audio-recorded and transcribed and a thematic content analysis was conducted. Most pediatric oncologists reported emotional difficulties in announcing treatment resistance. Some of them mentioned a personal need to accept resistance to treatment and to mourn the child's chances of recovery, and reported feelings of medical failure. This disclosure was considered more difficult than the announcement of the cancer diagnosis because it was associated with less optimism and more complex and fewer therapeutic options. The attachment bond created with families in the course of treatment seemed to exacerbate the emotional difficulties associated with this announcement. In conclusion, resistance to treatment has an impact on prognosis. It makes it more uncertain. Its announcement for pediatric oncologists is a turning point that affects their initial optimistic perspective. Their emotional difficulties are accentuated by the attachment that has been created with the families. Focusing on difficulties experienced by pediatricians could help to improve parent-pediatrician communication.
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Affiliation(s)
- Johanna Terrasson
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Étienne Seigneur
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Institut Curie, SIREDO Oncology Center, Paris, France
| | - Aude Rault
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Leïla El Mellah
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Sylvie Dolbeault
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Research Center in Epidemiology and Health Population, INSERM, U1018, Paris-Saclay University, Villejuif, France
| | - Anne Brédart
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Psychopathology and Health Process Laboratory, University of Paris, Boulogne-Billancourt, France
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Dolbeault S, Seigneur E. Enjeux cliniques de l’oncogénétique : qu’est-ce qui change en 2021 ? Des valeurs immuables aux innovations les plus récentes. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Brédart A, Kop JL, De Pauw A, Cano A, Dick J, Stoppa-Lyonnet D, Dolbeault S. Préoccupations et besoins d’aide psychologiques chez les femmes à risque génétique de cancer du sein ou de l’ovaire : une étude prospective observationnelle en Allemagne, Espagne et France. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2021-0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectifs et contexte : L’arrivée des tests de panel de gènes a augmenté la complexité de la communication en consultation d’oncogénétique. Une attention quant à l’impact de cette communication sur les préoccupations et les besoins d’aide psychologique s’avère d’autant plus indispensable. Cette étude vise à en quantifier le type et l’ampleur, avant et après la communication du résultat de test génétique, chez des femmes s’adressant à la consultation d’oncogénétique pour réaliser un test de susceptibilité au cancer du sein ou de l’ovaire en Allemagne, Espagne et France.
Participants et mesures : Parmi les 752 personnes invitées consécutivement à participer à cette étude, 646 (86 %) ― dont 510 (68 %) atteintes d’un cancer du sein―ont répondu à un questionnaire (PAHC (Psychosocial Aspects of Hereditary Cancer)) portant d’une part sur les préoccupations spécifiques à la démarche en oncogénétique et d’autre part sur leurs besoins d’aide psychologique ; questionnaire proposé après la consultation initiale d’oncogénétique initiale (T1) et, pour 460 (61 %) d’entre elles, deux mois après la communication du résultat du test (T2).
Résultats : Soixante-dix-neuf (17,2 %), 19 (4,1 %), 259 (56,3 %), 44 (9,6 %), 59 (12,8 %) femmes ont reçu respectivement les résultats suivants : un variant pathogène sur BRCA1/2 ou sur autre gène à risque élevé ou modéré, un résultat négatif non informatif, un résultat négatif vrai, ou la présence d’un variant dont la signification clinique est incertaine (VUS). Le type de préoccupations et les besoins d’aide psychologique se sont révélés variables selon les pays. Cependant, globalement, les préoccupations les plus fréquentes (> 70 %) étaient relatives à la perte d’un proche familial par cancer, et les moins fréquentes (< 5 %) relatives au soutien des proches. La plupart de ces préoccupations persistent deux mois plus tard, à la suite du résultat de test génétique. En revanche, le besoin d’aide psychologique a globalement diminué sur le plan statistique, excepté, selon le pays, pour les préoccupations familiales/sociales, les difficultés émotionnelles ou les aspects pratiques.
Conclusions : Dans notre étude portant sur des femmes issues de trois pays européens s’adressant à la consultation oncogénétique en vue de réaliser un test de susceptibilité au cancer du sein ou de l’ovaire, la plupart des préoccupations liées à la situation génétique persistent deux mois après la communication du résultat de test, et les besoins d’aide psychologique se manifestent surtout dans le champ des relations et des émotions.
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Brédart A, Rault A, Terrasson J, Seigneur E, De Koning L, Hess E, Savignoni A, Cottu P, Pierga JY, Piperno-Neumann S, Rodrigues M, Bouleuc C, Dolbeault S. Helping Patients Communicate With Oncologists When Cancer Treatment Resistance Occurs to Develop, Test, and Implement a Patient Communication Aid: Sequential Collaborative Mixed Methods Study. JMIR Res Protoc 2022; 11:e26414. [PMID: 35019850 PMCID: PMC8792782 DOI: 10.2196/26414] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most cancer-related deaths result from disseminated diseases that develop resistance to anticancer treatments. Inappropriate communication in this challenging situation may result in unmet patient information and support needs. Patient communication aids such as question prompt lists (QPLs) may help. OBJECTIVE This study aims to develop and pilot-test a specific QPL in the following two contrasting clinical contexts in France after cancer resistance has developed: triple-negative and luminal B metastatic breast cancer (MBC) and metastatic uveal melanoma (MUM). METHODS A sequential study design with a mixed methods collaborative approach will be applied. The first step aims to build a specific QPL. Step 1a will explore oncologist-patient communication issues from oncology professionals' interviews (n=20 approximately). Step 1b will appraise information and support needs experienced by patients with MBC or MUM both quantitatively (n=80) and qualitatively (n=40 approximately). These data will be used to develop and pilot-test a QPL specific to patients with cancer experiencing initial or acquired resistance to treatment. We expect to obtain a core QPL that comprises questions and concerns commonly expressed by patients with resistant cancer and is complemented by specific issues for either MBC or MUM cancer sites. In step 1c, 2 focus groups of patients with any type of metastatic cancer (n=4) and health care professionals (n=4) will be conducted to revise the content of a preliminary QPL and elaborate an acceptable and feasible clinical implementation. In step 1d, the content of the QPL version 1 and implementation guidance will be validated using a Delphi process. Step 2 will pilot-test the QPL version 1 in real practice with patients with MBC or MUM (n=80). Clinical utility will be assessed by comparing responses to questionnaires administered in step 1b (QPL-naive historical control group) and step 2 (QPL intervention group). RESULTS This study received grants in March and December 2019 and was approved by the French national ethics committee in July 2019. As of October 2021, interviews with oncology professionals have been conducted and analyzed (N=26 to reach saturation), and 39 and 27 patients with MBC and MUM, respectively, have been recruited. CONCLUSIONS A clinically and culturally tailored QPL is expected to facilitate patients' participation in consultations, improve oncologists' responses to patients' information and support needs, and thus foster patients' psychological adjustment to the diagnosis and follow-up of cancer resistance to treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT04118062; http://clinicaltrials.gov/ct2/show/NCT04118062. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26414.
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Affiliation(s)
- Anne Brédart
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France.,Psychopathology and Health Process, Paris University, Boulogne Billancourt, France
| | - Aude Rault
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Johanna Terrasson
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Etienne Seigneur
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Leanne De Koning
- Research Centre, Paris Sciences et Lettres Research University, Institut Curie, Paris, France
| | - Elisabeth Hess
- Research Centre, Paris Sciences et Lettres Research University, Institut Curie, Paris, France
| | - Alexia Savignoni
- Direction Recherche Ensemble Hospitalier, Data Management Unit, Biometry Department, Institut Curie, Saint-Cloud, France
| | - Paul Cottu
- Medical Oncology Department, Institut Curie, Paris, France
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie, Paris, France.,Faculty of medicine, Paris University, Paris, France
| | | | | | - Carole Bouleuc
- Département Interdisciplinaire de Soins de Support pour le Patient en Oncologie, Department of Supportive Care, Institut Curie, Paris, France
| | - Sylvie Dolbeault
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France.,Research Centre in Epidemiology and Population Health (CESP), INSERM, U1018, University Paris-Sud, Villejuif, France
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Rault A, Terrasson J, Dolbeault S, Brédart A. Réflexions cliniques et éthiques à partir d’une recherche menée en psycho-oncologie sur la communication lors de l’annonce de l’échec d’un traitement antitumoral. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cet article rend compte des divers questionnements cliniques et éthiques apparus au cours de notre recherche en psycho-oncologie. Celle-ci porte sur la communication entre les oncologues et leurs patients, et les pédiatres-oncologues et les parents d’enfants malades à un moment particulier de la prise en charge : l’annonce de la résistance au traitement antitumoral et l’absence d’alternative curative connue. La mise en place d’une telle étude nécessite de prendre en compte les aspects émotionnels et psychologiques en jeu. Dans un premier temps, nous présentons les interrogations portant sur le recrutement des participants : comment et quand les contacter ? Par la suite, nous questionnons le potentiel impact de cette recherche pour les participants : quels mots utiliser et quelles questions aborder ? Enfin, nous revenons sur les précautions à prendre dans l’interprétation et la transmission des résultats : quelles sont les incidences des choix méthodologiques ? À chaque étape, nos réflexions sont illustrées par des exemples concrets. Cet article met en exergue la nécessité de la réflexion à la fois clinique et éthique dans le domaine de la recherche en psycho-oncologie.
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Bansard E, Bouleuc C, Gaille M, Dolbeault S. Définir les soins de support : une contribution philosophique. PSYCHO-ONCOLOGIE 2021. [DOI: 10.3166/pson-2021-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Vingt ans après l’arrivée en France des soins de support, ce travail issu d’une thèse en philosophie sur les soins de support propose de faire le point sur leur définition et leur positionnement dans le système de soins. Il s’agit de décrire et de comprendre le flou conceptuel et la grande variété des offres de soins sur le territoire français et à l’international. En s’appuyant sur une analyse de la littérature et sur un travail de terrain, la place accordée aux patients en tant que partenaire des soins est proposée comme un fondement commun et structurant au sein de la diversité des pratiques. Nous interrogerons les liens entre la place des patients bénéficiant de soins de support et le modèle de « patient partenaire ». Là où le modèle dit « de Montréal » se réfère à un concept d’autonomie du patient, les soins de support proposent une attention et une adaptation à l’individu et à la fluctuation de ses besoins au cours du temps.
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Brédart A, De Pauw A, Anota A, Tüchler A, Dick J, Müller A, Kop JL, Rhiem K, Schmutzler R, Devilee P, Stoppa-Lyonnet D, Dolbeault S. Information needs on breast cancer genetic and non-genetic risk factors in relatives of women with a BRCA1/2 or PALB2 pathogenic variant. Breast 2021; 60:38-44. [PMID: 34455229 PMCID: PMC8403756 DOI: 10.1016/j.breast.2021.08.011] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/29/2021] [Accepted: 08/21/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Comprehensive breast cancer (BC) risk models integrating effects of genetic (GRF) and non-genetic risk factors (NGRF) may refine BC prevention recommendations. We explored the perceived information received on BC risk factors, and related characteristics, in female relatives of women with a BRCA1/2 or PALB2 pathogenic variant, undergoing BC risk assessment using the CanRisk© prediction tool. METHODS Of 200 consecutive cancer-free women approached after the initial genetic consultation, 161 (80.5%) filled in questionnaires on their perception of information received and wished further information on BC risk factors (e.g., being a carrier of a moderate risk altered gene, personal genetic profile, lifestyles). Multilevel multivariate linear models were performed accounting for the clinician who met the counselee and exploring the effect of counselees' socio-demographic, familial and psychological characteristics on the perceived extent of information received. RESULTS Perceived no/little information received and wish for further information were more frequent for NGRF (>50%) than for GRF, especially high-risk genes (<20%). Perceived amount of information received and desire for further information were inversely correlated (p=<0.0001). Higher education level related to lower perceived levels of information received on GRF. Younger counselees' age (β = 0.13, p = 0.02) and less frequent engagement coping (e.g., inclination to solicit information) (β = 0.24, p = 0.02) related to lower perceived information received about NGRF. Other assessed counselees' features were not found to be associated to GRF and NGRF information perception. CONCLUSIONS Awareness of counselees' perceived lack of information on BC risk factors indicates a need to enhance evidence-based information on BC NGRF especially.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, 26 rue d'Ulm, Paris, 75005 Paris Cedex 05, France; University of Paris, 71 Avenue Edouard Vaillant, Boulogne-Billancourt, 92774, France.
| | - Antoine De Pauw
- Institut Curie, Cancer Genetic Clinic, PSL University, 26 rue d'Ulm, 75005 Paris Cedex 05, France
| | - Amélie Anota
- Centre Léon Bérard, Department of Clinical Research and Innovation& Human and Social Sciences Department, 28 rue Laennec, Lyon; French National Platform Quality of Life and Cancer, Lyon, 69373, France
| | - Anja Tüchler
- Center for Familial Breast and Ovarian and Cancer for Integrated Oncology (CIO), Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - Julia Dick
- Center for Familial Breast and Ovarian and Cancer for Integrated Oncology (CIO), Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - Anita Müller
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, 26 rue d'Ulm, Paris, 75005 Paris Cedex 05, France; VCR, École de Psychologues Praticiens de l'Institut Catholique de Paris, 23 Rue du Montparnasse, 75006, Paris, France
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN, 3 Place Godefroy de Bouillon, Nancy, 54 015 Nancy Cedex, France
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian and Cancer for Integrated Oncology (CIO), Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - Rita Schmutzler
- Center for Familial Breast and Ovarian and Cancer for Integrated Oncology (CIO), Kerpener Str. 62 50937 Cologne, University Hospital of Cologne, Cologne, Germany
| | - Peter Devilee
- Leiden University Medical Centre, Department of Human Genetics, Department of Pathology, S4-P, P.O. Box 9600, 2300, RC, Leiden, the Netherlands
| | - Dominique Stoppa-Lyonnet
- Institut Curie, Cancer Genetic Clinic, PSL University, 26 rue d'Ulm, 75005 Paris Cedex 05, France
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, 26 rue d'Ulm, Paris, 75005 Paris Cedex 05, France; CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 Avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
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Dick J, Aue V, Wesselmann S, Brédart A, Dolbeault S, Devilee P, Stoppa-Lyonnet D, Schmutzler RK, Rhiem K. Survey on Physicians' Knowledge and Training Needs in Genetic Counseling in Germany. Breast Care (Basel) 2021; 16:389-395. [PMID: 34602945 DOI: 10.1159/000511136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/25/2020] [Indexed: 01/25/2023] Open
Abstract
Background In recent years, germline testing of women with a risk of developing breast and ovarian cancer has increased rapidly. This is due to lower costs for new high-throughput sequencing technologies and the manifold preventive and therapeutic options for germline mutation carriers. The growing demand for genetic counseling meets a shortfall of counselors and illustrates the need to involve the treating clinicians in the genetic testing process. This survey was undertaken to assess their state of knowledge and training needs in the field of genetic counseling and testing. Methods A cross-sectional survey within the European Bridges Study (Breast Cancer Risk after Diagnostic Gene Sequencing) was conducted among physician members (n = 111) of the German Cancer Society who were primarily gynecologists. It was designed to examine their experience in genetic counseling and testing. Results Overall, the study revealed a need for training in risk communication and clinical recommendations for persons at risk. One-third of respondents communicated only relative disease risks (31.5%) instead of absolute disease risks in manageable time spans. Moreover, almost one-third of the respondents (31.2%) communicated bilateral and contralateral risk-reducing mastectomy as an option for healthy women and unilateral-diseased breast cancer patients without mutations in high-risk genes (e.g. BRCA1 or BRCA2). Most respondents expressed training needs in the field of risk assessment models, the clinical interpretation of genetic test results, and the decision-making process. Conclusion The survey demonstrates a gap of genetic and risk literacy in a relevant proportion of physicians and the need for appropriate training concepts.
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Affiliation(s)
- Julia Dick
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Viktoria Aue
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | | | - Anne Brédart
- Supportive Care Department, Psycho-Oncology Unit, Institut Curie, Paris, France.,University Paris Descartes, Boulogne-Billancourt, France
| | - Sylvie Dolbeault
- Supportive Care Department, Psycho-Oncology Unit, Institut Curie, Paris, France.,Centre de Recherche en Épidémiologie et Santé des Populations (CESP), University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif Cedex, France
| | - Peter Devilee
- Departments of Human Genetics and Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Rita K Schmutzler
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Cologne, Germany
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Thery L, Vaflard P, Vuagnat P, Soulie O, Dolbeault S, Burnod A, Laouisset C, Marchal T, Massiani MA, Bozec L, Bidard FC, Cottu P, Angellier E, Bouleuc C. Advanced cancer and COVID-19 comorbidity: medical oncology-palliative medicine ethics meetings in a comprehensive cancer centre. BMJ Support Palliat Care 2021:bmjspcare-2021-002946. [PMID: 33927013 PMCID: PMC8098300 DOI: 10.1136/bmjspcare-2021-002946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES In managing patients with cancer in the COVID-19 era, clinical oncologists and palliative care practitioners had to face new, disrupting and complex medical situations, challenging the quality of the shared decision-making process. During the first lockdown in France, we developed an onco-palliative ethics meeting to enhance the quality of the decision-making process for patients with advanced cancer treated for COVID-19. METHODS A least one of the institutional ethics committee members was present along with oncologists, palliative care teams, psycho-oncologists, radiologists and intensive care specialists. Specific medical parameters were systematically collected to form a standardised framework for the discussions. RESULTS The main raised issues were the definition of new criteria for the implementation of invasive resuscitation techniques, optimal ways to adapt or delay anticancer treatment and best procedures to address terminal respiratory failure and end-of-life care. The main clinical and ethical guidelines that emerged during these debates are presented. The palliative care team played a major role in assessing and reporting patients' awareness of cancer-related prognosis and their wishes concerning invasive therapies or transfer to intensive care units, enabling an individualised benefit-risk balance assessment. The ethics committee members ensured continuous monitoring during the discussions. Their function was to recall the main ethical principles including dignity, which is conferred on people when there are treated as having equal status. CONCLUSIONS The onco-palliative ethics meeting provided a powerful avenue for improvement of collegiality and reinforcement of teamwork, which could be a major protection against burnout for healthcare professionals facing an epidemic onslaught.
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Affiliation(s)
- Laura Thery
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- PSL University, Paris, France
| | - Pauline Vaflard
- PSL University, Paris, France
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
| | - Perrine Vuagnat
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
- Paris-Saclay University, Saint-Aubin, France
| | - Ophélie Soulie
- PSL University, Paris, France
- Psycho-Oncology Unit, Institut Curie, Paris, France
| | - Sylvie Dolbeault
- PSL University, Paris, France
- Psycho-Oncology Unit, Institut Curie, Paris, France
| | - Alexis Burnod
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- PSL University, Paris, France
| | - Céline Laouisset
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- PSL University, Paris, France
| | - Timothée Marchal
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- PSL University, Paris, France
| | - Marie-Ange Massiani
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
- Paris-Saclay University, Saint-Aubin, France
| | - Laurence Bozec
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
- Paris-Saclay University, Saint-Aubin, France
| | - François-Clément Bidard
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
- Paris-Saclay University, Saint-Aubin, France
| | - Paul Cottu
- PSL University, Paris, France
- Department of Medical Oncology, Institut Curie, Paris et Saint-Cloud, France
| | - Elisabeth Angellier
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- Paris-Saclay University, Saint-Aubin, France
| | - Carole Bouleuc
- Department of Supportive and Palliative Care, Institut Curie, Paris et Saint-Cloud, France
- PSL University, Paris, France
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Thery L, Anota A, Waechter L, Laouisset C, Marchal T, Burnod A, Angellier E, Djoumakh OEK, Thebaut C, Brédart A, Dolbeault S, Mino JC, Bouleuc C. Palliative care in day-hospital for advanced cancer patients: a study protocol for a multicentre randomized controlled trial. BMC Palliat Care 2021; 20:61. [PMID: 33865379 PMCID: PMC8053288 DOI: 10.1186/s12904-021-00754-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/09/2020] [Accepted: 04/11/2021] [Indexed: 01/03/2023] Open
Abstract
Background Team-based and timely integrated palliative care is a gold standard of care in oncology, but issues concerning its optimal organization remain. Palliative Care in Day-Hospital (PCDH) could be one of the most efficient service model of palliative care to deliver interdisciplinary and multidimensional care addressing the complex supportive care needs of patients with advanced cancer. We hypothesize that, compared to conventional outpatient palliative care, PCDH allows the clinical benefits of palliative care to be enhanced. Methods/design This study is a multicentre parallel group trial with stratified randomization. Patient management in PCDH will be compared to conventional outpatient palliative care. The inclusion criteria are advanced cancer patients referred to a palliative care team with an estimated life expectancy of more than 2 months and less than 1 year. The primary endpoint is health-related quality of life with deterioration-free survival based on the EORTC QLQ-C30 questionnaire. The secondary objectives are the following: increase in patient satisfaction with care using the EORTC PATSAT-C33 and OUT-PATSAT7 questionnaires, better understanding of the prognosis using the PTPQ questionnaire and advance care planning; decrease in the need for supportive care among relatives using the SCNS-P&C-F questionnaire, and reduction in end-of-life care aggressiveness. Patients will complete one to five questionnaires on a tablet before each monthly visit over 6 months and will be followed for 1 year. A qualitative study will take place, aiming to understand the specificity of palliative care management in PCDH. Cost-effectiveness, cost-utility and, an additional economic evaluation based on capability approach will be conducted from a societal point of view. Discussion The first strength of this study is that it combines the main relevant outcomes assessing integrated palliative care; patient quality of life and satisfaction; discussion of the prognosis and advance care planning, family well-being and end-of-life care aggressiveness. The second strength of the study is that it is a mixed-method study associating a qualitative analysis of the specificity of PCDH organization, with a medical-economic study to analyse the cost of care. Trial registration Name of the registry: IDRCB 2019-A03116–51 Trial registration number:NCT04604873 Date of registration: October 27, 2020 URL of trial registry record
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Affiliation(s)
- Laura Thery
- Department of Supportive and Palliative Care, Institut Curie, Paris, France.
| | - Amélie Anota
- Biostatistics Unit, DRCI, Centre Léon Bérard, Lyon, France.,French National Platform Quality of Life and Cancer, Lyon, France.,INSERM, EFS-BFC, UMR 1098- Université de Bourgogne-Franche-Comté, Besançon, France
| | - Lorraine Waechter
- Department of Supportive and Palliative Care, Hôpital Cochin, Paris, France
| | - Celine Laouisset
- Department of Supportive and Palliative Care, Institut Curie, Paris, France
| | - Timothee Marchal
- Department of Supportive and Palliative Care, Institut Curie, Paris, France
| | - Alexis Burnod
- Department of Supportive and Palliative Care, Institut Curie, Paris, France
| | - Elisabeth Angellier
- Department of Supportive and Palliative Care, Institut Curie, Saint Cloud, Paris, France
| | - Oum El Kheir Djoumakh
- Methodological and Quality of Life Unit in Oncology (INSERM 1098), University Hospital, Besançon, France
| | - Clemence Thebaut
- Université de Limoges, UMR 1094 (NET), Limoges, France.,Université Paris-Dauphine, PSL Research, University, LEDa [Legos], Paris, France
| | - Anne Brédart
- Department of Psycho-Oncology, Institut Curie, Paris, France.,Laboratoire Psychopathologie et Processus de Santé, Université de Paris, F-92100, Boulogne Billancourt, Paris, France
| | | | | | - Carole Bouleuc
- Department of Supportive and Palliative Care, Institut Curie, Paris, France
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Terrasson J, Brédart A, El Mellah L, Doz F, Seigneur É, Dolbeault S. [Emotions Associated with Breaking Bad News in Pediatric Oncology and Parents-Pediatrician Communication: A Status Report]. Bull Cancer 2021; 108:399-414. [PMID: 33707034 DOI: 10.1016/j.bulcan.2020.11.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Abstract
This literature review aims to explain how the emotions aroused by the announcement of bad news in pediatric oncology affect communication between parents and pediatric oncologists. In the first part, we summarize the parents' expectations regarding communication with the pediatrician at this critical time in their child's care. Then, in a second part, we specify the influence that the emotions of pediatric oncologists and parents during these announcements can have on parent-pediatrician communication. In this context, the emotions and defense mechanisms of pediatric oncologists, parental distress as expressed by parents and as perceived or feared by pediatricians, are discussed. For this synthesis, we have endeavoured to select studies including both mothers and fathers. On the basis of the observations carried out in this review, we conclude by suggesting avenues for the practical implications and for future research. The continuation of research including both parents appears necessary to allow for a closer adaptation of the reactions and needs of each parent, particularly at key moments in the child's care, such as the announcement of bad news. Encouraging exchanges on the emotions felt within the medical and care team, particularly with the department psychologist, could be an opportunity for pediatricians to question their experience of the announcement of bad news and could promote the circulation of emotions in the parent-pediatrician relationship and communication.
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Affiliation(s)
- Johanna Terrasson
- Unité de Psycho-Oncologie, Institut Curie, PSL Université Paris, 75005 Paris, France.
| | - Anne Brédart
- Unité de Psycho-Oncologie, Institut Curie, PSL Université Paris, 75005 Paris, France; Laboratoire Psychopathologie et Processus de Santé, Université de Paris, 92100 Boulogne-Billancourt, France
| | - Leïla El Mellah
- Unité de Psycho-Oncologie, Institut Curie, PSL Université Paris, 75005 Paris, France
| | - François Doz
- Centre SIREDO - Soins, Innovation, Recherche, en oncologie de l'Enfant, de l'aDOlescent et de l'adulte jeune, Institut Curie, 75005 Paris, France; Université de Paris, 12, rue de l'École de Médecine, 75006 Paris, France; UMR 144 CNRS, Institut Curie, 75005 Paris, France
| | - Étienne Seigneur
- Unité de Psycho-Oncologie, Institut Curie, PSL Université Paris, 75005 Paris, France; Centre SIREDO - Soins, Innovation, Recherche, en oncologie de l'Enfant, de l'aDOlescent et de l'adulte jeune, Institut Curie, 75005 Paris, France
| | - Sylvie Dolbeault
- Unité de Psycho-Oncologie, Institut Curie, PSL Université Paris, 75005 Paris, France; Centre de recherche en Épidémiologie et Santé des Populations (CESP), Inserm, U1018, Université Paris-Sud, 94807 Villejuif, France
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Bouleuc C, Savignoni A, Chevrier M, Renault-Tessier E, Burnod A, Chvetzoff G, Poulain P, Copel L, Cottu P, Pierga JY, Brédart A, Dolbeault S. A Question Prompt List for Advanced Cancer Patients Promoting Advance Care Planning: A French Randomized Trial. J Pain Symptom Manage 2021; 61:331-341.e8. [PMID: 32739563 DOI: 10.1016/j.jpainsymman.2020.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 12/18/2022]
Abstract
CONTEXT Advance care planning is essential to enable informed medical decisions to be made and to reduce aggressiveness in end-of-life (EOL) care. OBJECTIVES This study aimed to explore whether a question prompt list (QPL) adapted to French language and culture could promote discussions, particularly on prognosis and EOL issues, among advanced cancer patients attending outpatient palliative care (PC) consultations. METHODS In this multicenter randomized study, patients assigned to the intervention arm received a QPL to help them prepare for the next consultation one month later. The main inclusion criteria were advanced cancer patients referred to the PC team with an estimated life expectancy of less than one year. The primary endpoint was the number of questions raised, globally and by topic. The secondary objectives were the impact of the QPL on psychological symptoms, quality of life, satisfaction with care, and coping styles at two months. RESULTS Patients (n = 71) in the QPL arm asked more questions (mean 21.8 vs. 18.2, P = 0.03) than patients in the control arm (n = 71), particularly on PC (5.6 vs. 3.7, P = 0.012) and EOL issues (2.2 vs. 1, P = 0.018) but not on prognosis (4.3 vs. 3.6, not specified). At two months, there was no change in anxiety, depression, or quality of life in either arm; patient satisfaction with doctors' technical skills was scored higher (P = 0.024), and avoidance coping responses were less frequent (self-distraction, P = 0.015; behavioral disengagement, P = 0.025) in the QPL arm. CONCLUSION Questions on PC and EOL issues in outpatient PC consultations were more frequent, and patient satisfaction was better when a QPL was made available before the consultation.
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Affiliation(s)
- Carole Bouleuc
- Supportive Care Department, Institut Curie, Palliative Care Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France.
| | - Alexia Savignoni
- Clinical Research Department, Institut Curie, Biometric Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | - Marion Chevrier
- Clinical Research Department, Institut Curie, Biometric Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | - Evelyne Renault-Tessier
- Supportive Care Department, Institut Curie, Palliative Care Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | - Alexis Burnod
- Supportive Care Department, Institut Curie, Palliative Care Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | | | - Phillipe Poulain
- Palliative Care Department, Polyclinique de l'Ormeau, Tarbes, France
| | - Laure Copel
- Palliative Care Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Paul Cottu
- Medical Oncology Department, Institut Curie, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France
| | - Anne Brédart
- Institut Curie, Psycho-Oncology Unit, Paris, France; Institute of Psychology, Paris Descartes University, Boulogne-Billancourt, France
| | - Sylvie Dolbeault
- Institut Curie, Psycho-Oncology Unit, Paris, France; CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
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Gehenne L, Lelorain S, Anota A, Brédart A, Dolbeault S, Sultan S, Piessen G, Grynberg D, Baudry A, Christophe V. Testing two competitive models of empathic communication in cancer care encounters: A factorial analysis of the CARE measure. Eur J Cancer Care (Engl) 2020; 29:e13306. [DOI: 10.1111/ecc.13306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/12/2020] [Accepted: 08/07/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Lucie Gehenne
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
| | - Sophie Lelorain
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit (IMSER UMR 1098) University of Besançon Besançon France
| | - Anne Brédart
- Psycho‐oncology and Social Service Institut Curie Paris France
- Psychopathology and Health Process Laboratory (LPPS UR 4057) Psychology Institute University Paris Descartes France
| | - Sylvie Dolbeault
- Psycho‐oncology and Social Service Institut Curie Paris France
- University Paris SudUniversity PSL Paris France
| | - Serge Sultan
- Sainte Justine University Health Center Montréal QC Canada
- Departments of Pediatrics and Psychology University of Montreal Montréal QC Canada
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery Claude Huriez University Hospital University of Lille Lille France
- Jean‐Pierre Aubert Research Center – Neurosciences and Cancer University of Lille (IMR‐S 1172‐JPArc) Lille France
| | - Delphine Grynberg
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
- Institut Universitaire de France Paris France
| | - Anne‐Sophie Baudry
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
- Oncology and Medical Specialties Department Valenciennes Hospital Valenciennes France
| | - Véronique Christophe
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
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Bouleuc C, Burnod A, Cottu PH, Pierga JY, Dolbeault S. Questions prompt lists used by palliative care teams help trigger discussions on prognosis and end-of-life issues with advanced cancer patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12110 Background: Accuracy of prognosis perception is a key element to allow advanced cancer patients to make informed decisions and to reflect on their end-of-life priorities. This study aims to explore whether a question prompt list can promote discussions on prognosis and end-of-life issues during palliative care consultations for advanced cancer patients. Methods: In this multicentric randomised study, patients assigned in the interventional arm receive a question prompt list during the first palliative care consultation (T1) after referral by oncologists. The primary endpoint is the number of questions asked by patients during the second palliative care consultation (T2) one month later. Secondary objectives are anxiety and depression, quality-of-life, satisfaction with care, coping assessed at baseline (T1) and at two months (T3). Palliative care teams from 3 french comprehensive cancer centers participate in the study. Main inclusion criteria were adult patients with metastatic non-haematological cancer referred to the palliative care team and with an estimated life expectancy less than one year. Results: Patients (n = 71) in the QPL arm asked more questions (mean 21.8 versus 18.2, p-value = 0.03) during the palliative care consultations compared to patients in the control arm (n = 71). These questions addressed palliative care (mean 5.6 versus 3.7, p-value = 0.012) and end-of-life issues (mean 2.2 versus 1, p = 0.018) more frequently than in the control arm. At two months, compared to baseline, there was no change in anxio-depressive symptoms or quality of life. Conclusions: QPL favours discussion on prognosis and end-of-life care during the palliative care consultations for advanced cancer patients. Clinical trial information: NCT02854293 .
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Affiliation(s)
- Carole Bouleuc
- Supportive Care Department, Institut Curie, Paris, France
| | - Alexis Burnod
- Supportive Care Department, Institut Curie, Paris, France
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Brédart A, Dick J, Cano A, Robieux L, De Pauw A, Schmutzler R, Stoppa-Lyonnet D, Dolbeault S, Kop JL. How to facilitate psychosocial adjustment in women tested for hereditary breast or ovarian cancer susceptibility? Insights from network analysis. Psychooncology 2019; 29:550-556. [PMID: 31823434 DOI: 10.1002/pon.5302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/16/2019] [Accepted: 11/18/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Increasingly complex genetics counseling requires guidance to facilitate counselees' psychosocial adjustment. We explored networks of inter-relationships among coping strategies and specific psychosocial difficulties in women tested for hereditary breast or ovarian cancer. METHODS Of 752 counselees consecutively approached, 646 (86%) completed questionnaires addressing coping strategies (Brief-COPE) and psychosocial difficulties (PAHC) after the initial genetic consultation (T1), and 460 (61%) of them again after the test result (T2). We applied network analysis comparing partial correlations among these questionnaire scales, according to the type of genetic test - single gene-targeted or multigene panel, test result and, before and after testing. RESULTS Overall, 98 (21.3%), 259 (56.3%), 59 (12.8%) and 44 (9.6%) women received a pathogenic variant, uninformative negative (panel testing), variant of uncertain significance (VUS) or true negative (targeted testing) result, respectively. In most networks, connections were strongest between avoidance and general negative emotions. Cognitive restructuring was inter-related to lower psychosocial difficulties. Avoidance and familial/social relationship difficulties were strongly related in women receiving a pathogenic variant. Stronger inter-relationships were also noticed between avoidance and worries about personal cancer and concerns about hereditary predisposition in women receiving a VUS result. Differences in the prominence of inter-relationships were observed by type of testing and assessment time. CONCLUSIONS Network analysis may be fruitful to highlight prominent inter-relationships among coping strategies and psychosocial difficulties, in women tested for HBOC susceptibility, offering guidance for counseling.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Psycho-Oncology Unit, Paris, France.,University Paris Descartes, Boulogne-Billancourt, France
| | - Julia Dick
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital, Cologne, Germany
| | | | | | | | - Rita Schmutzler
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital, Cologne, Germany
| | | | - Sylvie Dolbeault
- Institut Curie, Psycho-Oncology Unit, Paris, France.,Centre de Recherche en Épidémiologie et Santé des Populations (CESP), University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN-CEMA, Nancy, France
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Brédart A, Anota A, Dick J, Cano A, De Pauw A, Kop JL, Aaronson NK, Bleiker EM, Brunet J, Devilee P, Stoppa-Lyonnet D, Schmutzler R, Dolbeault S. The "Psychosocial Aspects in Hereditary Cancer" questionnaire in women attending breast cancer genetic clinics: Psychometric validation across French-, German- and Spanish-language versions. Eur J Cancer Care (Engl) 2019; 29:e13173. [PMID: 31571365 DOI: 10.1111/ecc.13173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/23/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND We performed a comprehensive assessment of the psychometrics of the "Psychosocial Aspects in Hereditary Cancer" (PAHC) questionnaire in French, German and Spanish. METHODS Women consecutively approached in Cancer Genetic Clinics completed the PAHC, distress and satisfaction questionnaires at pre-testing (T1) and after test result disclosure (T2). In addition to standard psychometric attributes, we assessed the PAHC ability to respond to change (i.e. improvement or deterioration from T1 to T2) in perceived difficulties and computed minimal important differences (MID) in PAHC scores as compared with self-reported needs for additional counselling. RESULTS Of 738 eligible counselees, 214 (90%) in France (Paris), 301 (92%) in Germany (Cologne) and 133 (77%) in Spain (Barcelona) completed the PAHC. A six-factor revised PAHC model yielded acceptable CFA goodness-of-fit indexes and good all scales internal consistencies. PAHC scales demonstrated expected conceptual differences with distress and satisfaction with counselling. Different levels of psychosocial difficulties were evidenced between counselees' subgroups and over time (p-values < .05). MID estimates ranged from 8 to 15 for improvement and 9 to 21 for deterioration. CONCLUSION The PAHC French, German and Spanish versions are reliable and valid for evaluating the psychosocial difficulties of women at high BC risk attending genetic clinics.
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Affiliation(s)
- Anne Brédart
- Supportive Care Department, Psycho-oncology Unit, Psychopathology and Health Process Laboratory, EA 4047, Psychology Institute, Institut Curie, University Paris Descartes, Paris, France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology unit (INSERM UMR 1098), University Hospital of Besançon and French National Platform Quality of Life and Cancer, Besançon, France
| | - Julia Dick
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alejandra Cano
- Clinical and Health Psychology Department, University Autónoma of Barcelona, Barcelona, Spain
| | | | - Jean-Luc Kop
- Université de Lorraine, 2LPN (CEMA), Nancy, France
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eveline M Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joan Brunet
- Catalan Institute of Oncology, Barcelona, Spain
| | - Peter Devilee
- Department of Human Genetics & Division of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rita Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, Paris and CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
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Brédart A, Kop JL, Dick J, Cano A, De Pauw A, Anota A, Brunet J, Devilee P, Stoppa-Lyonnet D, Schmutzler R, Dolbeault S. Psychosocial problems in women attending French, German and Spanish genetics clinics before and after targeted or multigene testing results: an observational prospective study. BMJ Open 2019; 9:e029926. [PMID: 31551380 PMCID: PMC6773290 DOI: 10.1136/bmjopen-2019-029926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES AND SETTING Advances in multigene panel testing for cancer susceptibility has increased the complexity of counselling, requiring particular attention to counselees' psychosocial needs. Changes in psychosocial problems before and after genetic testing were prospectively compared between genetic test results in women tested for breast or ovarian cancer genetic susceptibility in French, German and Spanish clinics. PARTICIPANTS AND MEASURES Among 752 counselees consecutively approached, 646 (86%) were assessed after the initial genetic consultation (T1), including 510 (68%) affected with breast cancer, of which 460 (61%) were assessed again after receiving the test result (T2), using questionnaires addressing genetic-specific psychosocial problems (Psychosocial Aspects of Hereditary Cancer (PAHC)-six scales). Sociodemographic and clinical data were also collected. RESULTS Seventy-nine (17.2%), 19 (4.1%), 259 (56.3%), 44 (9.6%) and 59 (12.8%) women received a BRCA1/2, another high/moderate-risk pathogenic variant (PV), negative uninformative, true negative (TN) or variant of uncertain significance result (VUS), respectively. On multiple regression analyses, compared with women receiving another result, those with a VUS decreased more in psychosocial problems related to hereditary predisposition (eg, coping with the test result) (ß=-0.11, p<0.05) and familial/social issues (eg, risk communication) (ß=-0.13, p<0.05), almost independently from their problems before testing. Women with a PV presented no change in hereditary predisposition problems and, so as women with a TN result, a non-significant increase in familial/social issues. Other PAHC scales (ie, emotions, familial cancer, personal cancer and children-related issues) were not affected by genetic testing. CONCLUSIONS In women tested for breast or ovarian cancer genetic risk in European genetics clinics, psychosocial problems were mostly unaffected by genetic testing. Apart from women receiving a VUS result, those with another test result presented unchanged needs in counselling in particular about hereditary predisposition and familial/social issues.
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Affiliation(s)
- Anne Brédart
- Department of Supportive Care, Psycho-Oncology Unit, Institut Curie, Paris, France
- Psychopathology and Health Process Laboratory, University Paris Descartes, Boulogne-Billancourt, Paris, France
| | - Jean-Luc Kop
- Département de Psychologie, Université de Lorraine, 2LPN (CEMA), Nancy, France
| | - Julia Dick
- Familial Breast and Ovarian Cancer Centre and Faculty of Medicine, Cologne University Hospital, Cologne, Germany
| | - Alejandra Cano
- Clinical and Health Psychology Department, University Autónoma of Barcelona, Barcelona, Spain
| | | | - Amélie Anota
- French National Quality of Life in Oncology Platform, and Methodology; Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Joan Brunet
- Medical Oncology Department, Catalan Institute of Oncology, Barcelona, Spain
| | - Peter Devilee
- Division of Pathology; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rita Schmutzler
- Familial Breast and Ovarian Cancer Centre and Faculty of Medicine, Cologne University Hospital, Cologne, Germany
| | - Sylvie Dolbeault
- Department of Supportive Care, Psycho-Oncology Unit, Institut Curie, Paris, France
- CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif, France
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Brédart A, Kop JL, Antoniou AC, Cunningham AP, De Pauw A, Tischkowitz M, Ehrencrona H, Schmidt MK, Dolbeault S, Rhiem K, Easton DF, Devilee P, Stoppa-Lyonnet D, Schmutzler R. Correction to: Clinicians' use of breast cancer risk assessment tools according to their perceived importance of breast cancer risk factors: an international survey. J Community Genet 2019; 10:531. [PMID: 31332717 DOI: 10.1007/s12687-019-00431-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The published online version contains mistake in author list. The correct presentation of the name Rita Schmutlzer is Rita Schmutzler.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-Oncology Unit, 26 rue d'Ulm, 75005, Paris, Cedex 05, France. .,University Paris Descartes, 71 avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN-CEMA, 23 boulevard Albert 1er-BP, 60446-54001, Cedex Nancy, France
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Alex P Cunningham
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Antoine De Pauw
- Institut Curie, Cancer genetic clinic, 26 rue d'Ulm, 75005, Paris, Cedex 05, France
| | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge, Box 238, Level 6 Addenbrooke's Treatment Centre Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Hans Ehrencrona
- Department of Clinical Genetics, Laboratory Medicine, Office for Medical Services and Department of Clinical Genetics, Lund University, 221 85, Lund, Sweden
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Division of Molecular Pathology, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-Oncology Unit, 26 rue d'Ulm, 75005, Paris, Cedex 05, France.,CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif, France
| | - Kerstin Rhiem
- Familial Breast and Ovarian Cancer Centre, Cologne University, Hospital and Faculty of Medicine, Kerpener Str. 34, I 50931, Cologne, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Peter Devilee
- Department of Human Genetics, Department of Pathology, Leiden University Medical Centre, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Rita Schmutzler
- Familial Breast and Ovarian Cancer Centre, Cologne University, Hospital and Faculty of Medicine, Kerpener Str. 34, I 50931, Cologne, Germany
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Brédart A, Kop JL, Antoniou AC, Cunningham AP, De Pauw A, Tischkowitz M, Ehrencrona H, Schmidt MK, Dolbeault S, Rhiem K, Easton DF, Devilee P, Stoppa-Lyonnet D, Schmutlzer R. Clinicians' use of breast cancer risk assessment tools according to their perceived importance of breast cancer risk factors: an international survey. J Community Genet 2019; 10:61-71. [PMID: 29508368 PMCID: PMC6325038 DOI: 10.1007/s12687-018-0362-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/20/2018] [Indexed: 01/31/2023] Open
Abstract
The BOADICEA breast cancer (BC) risk assessment model and its associated Web Application v3 (BWA) tool are being extended to incorporate additional genetic and non-genetic BC risk factors. From an online survey through the BOADICEA website and UK, Dutch, French and Swedish national genetic societies, we explored the relationships between the usage frequencies of the BWA and six other common BC risk assessment tools and respondents' perceived importance of BC risk factors. Respondents (N = 443) varied in age, country and clinical seniority but comprised mainly genetics health professionals (82%) and BWA users (93%). Oncology professionals perceived reproductive, hormonal (exogenous) and lifestyle BC risk factors as more important in BC risk assessment compared to genetics professionals (p values < 0.05 to 0.0001). BWA was used more frequently by respondents who gave high weight to breast tumour pathology and low weight to personal BC history as BC risk factors. BWA use was positively related to the weight given to hormonal BC risk factors. The importance attributed to lifestyle and BMI BC risk factors was not associated with the use of BWA or any of the other tools. Next version of the BWA encompassing additional BC risk factors will facilitate more comprehensive BC risk assessment in genetics and oncology practice.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-Oncology Unit, 26 rue d'Ulm, 75005 Cedex 05, Paris, France.
- University Paris Descartes, 71 avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, 2LPN-CEMA, 23 boulevard Albert 1er-BP, 60446-54001 Cedex, Nancy, France
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Alex P Cunningham
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Antoine De Pauw
- Institut Curie, Cancer genetic clinic, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge, Box 238, Level 6 Addenbrooke's Treatment Centre Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Hans Ehrencrona
- Department of Clinical Genetics, Laboratory Medicine, Office for Medical Services and Department of Clinical Genetics, Lund University, 221 85, Lund, Sweden
| | - Marjanka K Schmidt
- Netherlands Cancer Institute, Division of Molecular Pathology, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-Oncology Unit, 26 rue d'Ulm, 75005 Cedex 05, Paris, France
- CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif, France
| | - Kerstin Rhiem
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34, I 50931, Cologne, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Worts Causeway, CB1 8RN, University of Cambridge, Cambridge, UK
| | - Peter Devilee
- Department of Human Genetics, Department of Pathology, Leiden University Medical Centre, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Rita Schmutlzer
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34, I 50931, Cologne, Germany
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Dolbeault S, Reich M. Maladie mentale et cancer. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Flahault C, Dolbeault S, Sankey C, Fasse L. Understanding grief in children who have lost a parent with cancer: How do they give meaning to this experience? Results of an interpretative phenomenological analysis. Death Stud 2018; 42:483-490. [PMID: 29173097 DOI: 10.1080/07481187.2017.1383951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Though the adjustment of bereaved children is increasingly investigated through quantitative studies, their intimate representations regarding the loss of their parent remain unknown. This qualitative study aims at exploring how they give meaning to this experience. Nondirective interviews with bereaved children were conducted and submitted to an interpretative phenomenological analysis. Fourteen children (8 boys, 6 girls, mean age = 8.5 years) were recruited. Seven major themes depicting their grief experience were identified. The importance of the surviving parent is critically highlighted. Findings suggest that the remaining parent could become a fundamental actor in providing grief support for the bereaved children.
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Affiliation(s)
- Cécile Flahault
- a Laboratory of Psychopathology and Health Process , Paris Descartes University , IUPDP , Paris , France
| | - S Dolbeault
- b UPO, Curie Institute , IUPDP , Paris , France
| | - C Sankey
- a Laboratory of Psychopathology and Health Process , Paris Descartes University , IUPDP , Paris , France
| | - L Fasse
- c Laboratory of Psychology, Relational Dynamics and Identity Process , University of Burgundy , Dijon , France
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Brédart A, Kop JL, Antoniou AC, Cunningham AP, De Pauw A, Tischkowitz M, Ehrencrona H, Dolbeault S, Robieux L, Rhiem K, Easton DF, Devilee P, Stoppa-Lyonnet D, Schmutlzer R. Corrections to: Use of the BOADICEA Web Application in clinical practice: appraisals by clinicians from various countries. Fam Cancer 2018; 17:469. [PMID: 29071503 PMCID: PMC6828123 DOI: 10.1007/s10689-017-0051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The article "Use of the BOADICEA Web Application in clinical practice: appraisals by clinicians from various countries" written by Anne Brédart · Jean‑Luc Kop · Antonis C. Antoniou · Alex P. Cunningham · Antoine De Pauw ·Marc Tischkowitz · Hans Ehrencrona · Sylvie Dolbeault · Léonore Robieux · Kerstin Rhiem ·Douglas F. Easton · Peter Devilee · Dominique Stoppa‑Lyonnet· Rita Schmutlzer, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 16th June 2017 without open access.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psychooncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France.
- University Paris Descartes, 71 avenue Edouard Vaillant, 92774, Boulogne‑Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, Inter‑Psy, 3 Place Godefroy de Bouillon, 54015, Nancy Cedex, France
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Alex P Cunningham
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Antoine De Pauw
- Institut Curie, Cancer Genetic Clinic, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge, Level 6 Addenbrooke's Treatment Centre Cambridge Biomedical Campus, Box 238, Cambridge, CB2 0QQ, UK
| | - Hans Ehrencrona
- Department of Clinical Genetics, Laboratory Medicine, Office for Medical Services and Department of Clinical Genetics, Lund University, Universitetssjukhuset, 221 85, Lund, Sweden
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psychooncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France
- CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 Avenue Paul Vaillant‑Couturier, 94807, Villejuif Cedex, France
| | - Léonore Robieux
- University Paris Descartes, 71 avenue Edouard Vaillant, 92774, Boulogne‑Billancourt, France
| | - Kerstin Rhiem
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34 I, 50931, Cologne, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Peter Devilee
- Department of Human Genetics, Department of Pathology, Leiden University Medical Centre, S4‑P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Rita Schmutlzer
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34 I, 50931, Cologne, Germany
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Brédart A, Kop JL, Antoniou AC, Cunningham AP, De Pauw A, Tischkowitz M, Ehrencrona H, Dolbeault S, Robieux L, Rhiem K, Easton DF, Devilee P, Stoppa-Lyonnet D, Schmutlzer R. Use of the BOADICEA Web Application in clinical practice: appraisals by clinicians from various countries. Fam Cancer 2018; 17:31-41. [PMID: 28623477 PMCID: PMC5770489 DOI: 10.1007/s10689-017-0014-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 'BOADICEA' Web Application (BWA) used to assess breast cancer risk, is currently being further developed, to integrate additional genetic and non-genetic factors. We surveyed clinicians' perceived acceptability of the existing BWA v3. An online survey was conducted through the BOADICEA website, and the British, Dutch, French and Swedish genetics societies. Cross-sectional data from 443 participants who provided at least 50% responses were analysed. Respondents varied in age and, clinical seniority, but mainly comprised women (77%) and genetics professionals (82%). Some expressed negative opinions about the scientific validity of BOADICEA (9%) and BWA v3 risk presentations (7-9%). Data entry time (62%), clinical utility (22%) and ease of communicating BWA v3 risks (13-17%) received additional negative appraisals. In multivariate analyses, controlling for gender and country, data entry time was perceived as longer by genetic counsellors than clinical geneticists (p < 0.05). Respondents who (1) considered hormonal BC risk factors as more important (p < 0.01), and (2) communicated numerical risk estimates more frequently (p < 0.001), judged BWA v3 of lower clinical utility. Respondents who carried out less frequent clinical activity (p < 0.01) and respondents with '11 to 15 years' seniority (p < 0.01) had less favourable opinions of BWA v3 risk presentations. Seniority of '6 to 10 years' (p < 0.05) and more frequent numerical risk communication (p < 0.05) were associated with higher fear of communicating the BWA v3 risks to patients. The level of genetics training did not affect opinions. Further development of BWA should consider technological, genetics service delivery and training initiatives.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France.
- University Paris Descartes, 71 avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, Inter-Psy, 3 Place Godefroy de Bouillon, 54015, Nancy Cedex, France
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Alex P Cunningham
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Antoine De Pauw
- Institut Curie, Cancer Genetic Clinic, 26 rue d'Ulm, 75005, Paris Cedex 05, France
| | - Marc Tischkowitz
- Department of Medical Genetics, University of Cambridge, Level 6 Addenbrooke's Treatment Centre Cambridge Biomedical Campus, Box 238, Cambridge, CB2 0QQ, UK
| | - Hans Ehrencrona
- Department of Clinical Genetics, Laboratory Medicine, Office for Medical Services and Department of Clinical Genetics, Lund University, Universitetssjukhuset, 221 85, Lund, Sweden
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, 26 rue d'Ulm, 75005, Paris Cedex 05, France
- CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, 16 Avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
| | - Léonore Robieux
- University Paris Descartes, 71 avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France
| | - Kerstin Rhiem
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34 I, 50931, Cologne, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Peter Devilee
- Department of Human Genetics, Department of Pathology, Leiden University Medical Centre, S4-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Rita Schmutlzer
- Familial Breast and Ovarian Cancer Centre, Cologne University Hospital and Faculty of Medicine, Kerpener Str. 34 I, 50931, Cologne, Germany
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Brédart A, Kop JL, De Pauw A, Caron O, Fajac A, Noguès C, Stoppa-Lyonnet D, Dolbeault S. Effect on perceived control and psychological distress of genetic knowledge in women with breast cancer receiving a BRCA1/2 test result. Breast 2016; 31:121-127. [PMID: 27837705 DOI: 10.1016/j.breast.2016.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 01/28/2023] Open
Abstract
Information provision during BRCA1/2 genetic counseling is complex and expected to be increasingly so with gene panel testing. This prospective study evaluated whether genetic knowledge in counselees with breast cancer (BC) after a pre-test genetic counseling visit (T1) enhance their feeling of personal control while minimizing distress after the notification of BRCA1/2 result (T2). At T1, 243 (89% response rate) counselees completed questionnaires on genetic knowledge (BGKQ), perceived cancer genetic risk; of which, at T2, 180 (66%) completed the BGKQ again, scales of anxiety/depression, distress specific to genetic risk, and perceived control. Multilevel models were performed accounting for clinician, and testing an effect of knowledge on psychological outcomes according to the adequacy of counselees' perceived genetic predisposition to cancer. The mean knowledge score was moderate at T1, decreased while not significantly differing by BRCA1/2 test result at T2. Knowledge at T1 had no direct effect on psychological outcomes, but in counselees who over-estimated their cancer genetic risk, higher knowledge at T1 predicted higher specific distress at T2. In BC affected counselees who over-estimate their cancer genetic risk, higher BRCA1/2 pre-test genetic knowledge seem to lead to increased specific distress. Identifying these BC affected counselees who over-estimate their genetic cancer risk and helping them to interpret their genetic knowledge instead of providing them with exhaustive genetic information could minimize their distress after test result receipt.
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Affiliation(s)
- Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit 26 rue d'Ulm, 75005 Paris Cedex 05, France; University Paris Descartes, 71, Avenue Edouard Vaillant, 92774 Boulogne-Billancourt, France.
| | - Jean-Luc Kop
- Université de Lorraine, Inter-Psy, Inter-Psy, 3 Place Godefroy de Bouillon, BP 33 97, 54 015 Nancy Cedex, France
| | - Antoine De Pauw
- Institut Curie, Cancer Genetic Clinic, 26 rue d'Ulm, 75005 Paris Cedex 05, France
| | - Olivier Caron
- Gustave Roussy Hôpital Universitaire, Cancer Genetic Clinic, 114 rue Ed Vaillant, 94 805 Villejuif, France
| | - Anne Fajac
- Hôpital Tenon Service d'Histologie-Biologie Tumorale, AP-HP, ER2 UPMC Université Pierre et Marie Curie, 4 rue de la Chine, 75020, France
| | - Catherine Noguès
- Institut Paoli-Calmettes, 232, Boulevard Sainte Margueritte, Marseille, France
| | | | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit 26 rue d'Ulm, 75005 Paris Cedex 05, France; CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
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Brédart A, Bodson S, Le Tourneau C, Flahault C, Bonnetain F, Beaudeau A, Coquan E, Dolbeault S, Paoletti X. Patients' perceived tolerance of side effects in phase I cancer clinical trials: A qualitative study. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27734561 DOI: 10.1111/ecc.12596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/18/2022]
Abstract
This qualitative study aimed to explore cancer patients' perceived tolerance of side effects in phase I drug trials. Patients with solid tumours receiving molecularly targeted agents with/without chemotherapy were eligible for inclusion. In-depth semi-structured interviews were carried out with 17 patients with a median [range] age of 63 [41-72] years. Treatment was discontinued in seven patients. Verbatim transcripts of the audio-taped interviews were analysed using a constructivist grounded theory approach. Four conceptual categories emerged from data analysis, labelled "suffering from side effects" comprising a range of symptoms, psychosocial or role disturbances; "striving to cope with side effects" reflecting psychological strategies for managing side effects; "hoping" reflecting expectations about treatment efficacy and relief from side effects; and "appraisal of care." Among patients remaining in the trial, treatment was currently perceived as fairly tolerable. For most respondents, whether still in a trial or not, treatment discontinuation could not be justified by the non-tolerance of treatment side effects. These results question the adequacy of patient-perceived tolerance reports to determine an optimal drug dose for phase II trials. Confronted with patients' hopes and inappropriate beliefs, communication is challenging in phase I trials and could benefit from facilitating psychosocial interventions.
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Affiliation(s)
- A Brédart
- Psycho-Oncology Unit, Institut Curie, Paris, France.,Psychopathology and Health Process Laboratory (EA 4057), Psychology Institute, University Paris Descartes, Boulogne-Billancourt, France
| | - S Bodson
- Psychopathology and Health Process Laboratory (EA 4057), Psychology Institute, University Paris Descartes, Boulogne-Billancourt, France
| | - C Le Tourneau
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France.,EA7285, Versailles-Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - C Flahault
- Psycho-Oncology Unit, Institut Curie, Paris, France.,Psychopathology and Health Process Laboratory (EA 4057), Psychology Institute, University Paris Descartes, Boulogne-Billancourt, France
| | - F Bonnetain
- Methodology and Quality of Life in Oncology Unit (EA 3181) & Quality of Life and Cancer Clinical Research Platform, CHU Besançon, France
| | - A Beaudeau
- Psycho-Oncology Unit, Institut Curie, Paris, France
| | - E Coquan
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France.,EA7285, Versailles-Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - S Dolbeault
- Psycho-Oncology Unit, Institut Curie, Paris, France.,Inserm, U 669, Paris, France
| | - X Paoletti
- Gustave Roussy Cancer Campus, Villejuif, France
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Dolbeault S, Brédart A. [Sexual wellbeing integrated into support care in oncology]. Rev Infirm 2016; 222:24-26. [PMID: 27317818 DOI: 10.1016/j.revinf.2016.04.005] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
All cancers have psychological and social repercussions which can impact on the patient's sexual quality of life. While the subject is still taboo, support care, which involves different professionals working together, is increasingly offering patients the opportunity to talk and become informed about these issues.
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Affiliation(s)
- Sylvie Dolbeault
- Département interdisciplinaire de soins de support Institut Curie, 26 rue d'Ulm, 75248 Paris cedex 05, France; Inserm U669, 97 bd de Port-Royal, 75679 Paris cedex 14, France.
| | - Anne Brédart
- Département interdisciplinaire de soins de support Institut Curie, 26 rue d'Ulm, 75248 Paris cedex 05, France; Université Paris-Descartes, LPPS EA 4057, 71 avenue Édouard-Vaillant, 92774 Boulogne Billancourt cedex, France
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35
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Brédart A, Untas A, Copel L, Leufroy M, Mino JC, Boiron C, Dolbeault S, Kop JL. Breast Cancer Survivors' Supportive Care Needs, Posttraumatic Growth and Satisfaction with Doctors' Interpersonal Skills in Relation to Physical Activity 8 Months after the End of Treatment: A Prospective Exploratory Study. Oncology 2016; 90:151-9. [PMID: 26882537 DOI: 10.1159/000443766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/23/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We assessed whether breast cancer survivors' (BCSs) supportive care needs, posttraumatic growth (positive psychological changes) and satisfaction with doctors' interpersonal skills could be related to physical activity (PA). METHODS A total of 426 BCSs were approached during the last week of treatment. Eight months later, 278 (65%) provided information on their PA levels. Ordinal logistic multiple regressions were performed. RESULTS PA levels included no PA (n = 68), some PA (n = 83), high PA levels more than twice or more than 2 h per week (n = 127). The multivariate model significantly explained 13% of PA variance (p = 0.001). An increase in posttraumatic growth total scores (proportional OR = 1.310; p < 0.05) and a decrease in physical and daily living supportive care needs subscale scores (proportional OR = 0.980; p < 0.001) and in satisfaction with doctors' interpersonal skill scores (proportional OR = 0.898; p < 0.05) were significantly associated with an increase in the likelihood of performing higher levels of PA. A lower educational level was associated with a decrease in the likelihood of performing PA. CONCLUSION The prevalence of PA in BCSs should be improved. Positive psychological changes after a breast cancer experience might contribute to performing PA. Encouraging PA needs to be accompanied by the alleviation of physical symptoms.
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Affiliation(s)
- Anne Brédart
- Psychology Institute, LPPS EA 4057, University Paris Descartes, Sorbonne Paris Citx00E9;, Boulogne-Billancourt, France
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Abstract
It is important to support patients with cancer during their care pathway and even beyond. They undergo long and difficult treatments, all anxiety-causing situations and sources of stress. Sophrological techniques help patients to find calm, lessen their fears and offer them the opportunity to work on themselves through simple easily reproducible exercises. This observation has been verified by a study carried out at the Institut Curie with patients undergoing chemotherapy.
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Affiliation(s)
- Chantal Barré
- Institut Curie, 26, rue d'Ulm, 75231 Paris cedex 05, France.
| | | | | | - Sylvie Carrié
- Institut Curie, 26, rue d'Ulm, 75231 Paris cedex 05, France
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Affiliation(s)
- S Dauchy
- Gustave Roussy, Villejuif, France
| | | | - M Reich
- Centre Oscar Lambret, Lille, France
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Lelorain S, Brédart A, Dolbeault S, Cano A, Bonnaud-Antignac A, Cousson-Gélie F, Sultan S. How does a physician's accurate understanding of a cancer patient's unmet needs contribute to patient perception of physician empathy? Patient Educ Couns 2015; 98:734-741. [PMID: 25817423 DOI: 10.1016/j.pec.2015.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 02/19/2015] [Accepted: 03/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Unmet supportive care needs of patients decrease patient perception of physician empathy (PE). We explored whether the accurate physician understanding of a given patient's unmet needs (AU), could buffer the adverse effect of these unmet needs on PE. METHODS In a cross-sectional design, 28 physicians and 201 metastatic cancer patients independently assessed the unmet supportive care needs of patients. AU was calculated as the sum of items for which physicians correctly rated the level of patient needs. PE and covariates were assessed using self-reported questionnaires. Multilevel analyses were carried out. RESULTS AU did not directly affect PE but acted as a moderator. When patients were highly expressive and when physicians perceived poor rapport with the patient, a high AU moderated the adverse effect of patient unmet needs on PE. CONCLUSION Physician AU has the power to protect the doctor-patient relationship in spite of high patient unmet needs, but only in certain conditions. PRACTICE IMPLICATIONS Physicians should be encouraged toward AU but warned that high rapport and patient low emotional expression may impede an accurate reading of patients. In this latter case, they should request a formal assessment of their patients' needs.
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Affiliation(s)
- Sophie Lelorain
- Univ Lille Nord de France, Department of Psychology, Lille, France; UDL3, SCALab UMR CNRS 9193, Villeneuve d'Ascq, France.
| | - Anne Brédart
- Institut Curie, Psycho-oncology Unit, Paris, France; Paris Descartes University, LPPS EA 4057-IUPDP, Boulogne-Billancourt, France
| | - Sylvie Dolbeault
- Institut Curie, Psycho-oncology Unit, Paris, France; Inserm, U 669, Paris, France; Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France
| | | | - Angélique Bonnaud-Antignac
- University of Nantes, EA4275 SPHERE 'bioStatistics, Pharmacoepidemiology and Human sciEnces Research', Nantes, France
| | - Florence Cousson-Gélie
- University of Montpellier 3, Laboratory Epsylon 'Dynamics of Human Abilities & Health Behaviors', Montpellier, France; ICM, Institut Régional du Cancer de Montpellier, Epidaure Prevention and Education Cancer Center, Montpellier, France
| | - Serge Sultan
- University of Montreal, Sainte Justine University Hospital Research Center, Montreal, Canada
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Brédart A, Kop JL, Fiszer C, Sigal-Zafrani B, Dolbeault S. Breast cancer survivors' perceived medical communication competence and satisfaction with care at the end of treatment. Psychooncology 2015; 24:1670-8. [DOI: 10.1002/pon.3836] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/22/2015] [Accepted: 04/03/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Anne Brédart
- Psycho-Oncology Unit; Supportive Care Department; Institute Curie; Paris France
- Psychology Institute, LPPS EA 4057; University Paris Descartes; Paris France
| | | | - Chavie Fiszer
- Psycho-Oncology Unit; Supportive Care Department; Institute Curie; Paris France
- Psychology Institute, LPPS EA 4057; University Paris Descartes; Paris France
| | | | - Sylvie Dolbeault
- Psycho-Oncology Unit; Supportive Care Department; Institute Curie; Paris France
- Inserm; Paris France
- University Paris-Sud and UMR-S0669; Paris France
- University Paris Descartes; Paris France
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40
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Grégoire S, Flahault C, Laurence V, Levy D, Dolbeault S. [Adolescents and young adults with cancer between adaptation and addiction: state of the question]. Bull Cancer 2015; 102:477-83. [PMID: 25953377 DOI: 10.1016/j.bulcan.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this literature review is to make a point on the state of health of adolescents and young adults (15-25 years) suffering from cancer. The adaptation strategies and the impact of the announcement of cancer will be discussed. In addition, we are going to consider the characteristics of teenagers and young adults, given the fact that development is still in progress. This period is especially punctuated by various experiments and the emergence of some clinical signs. Also, we have identified various studies concerning the use of licit and illicit substances. Furthermore, we have taken interest in behavioral addictions, particularly cyber addiction. While trying to cross these variables with a population of teenagers and young adults in the context of somatic diseases, it occurred that this population was not well known and studied. The interest of this synthesis is to underline the importance to make future researches in these perspectives.
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Affiliation(s)
- Solène Grégoire
- Université Paris-Descartes, institut de psychologie, laboratoire de psychopathologie et processus de santé EA 4057, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France.
| | - Cécile Flahault
- Université Paris-Descartes, institut de psychologie, laboratoire de psychopathologie et processus de santé EA 4057, 71, avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France.
| | | | - Dominique Levy
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 5, France.
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Gouveia L, Lelorain S, Brédart A, Dolbeault S, Bonnaud-Antignac A, Cousson-Gélie F, Sultan S. Oncologists' perception of depressive symptoms in patients with advanced cancer: accuracy and relational correlates. BMC Psychol 2015; 3:6. [PMID: 25815195 PMCID: PMC4359512 DOI: 10.1186/s40359-015-0063-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 11/24/2014] [Accepted: 02/19/2015] [Indexed: 11/18/2022] Open
Abstract
Background Health care providers often inaccurately perceive depression in cancer patients. The principal aim of this study was to examine oncologist-patient agreement on specific depressive symptoms, and to identify potential predictors of accurate detection. Methods 201 adult advanced cancer patients (recruited across four French oncology units) and their oncologists (N = 28) reported depressive symptoms with eight core symptoms from the BDI-SF. Various indices of agreement, as well as logistic regression analyses were employed to analyse data. Results For individual symptoms, medians for sensitivity and specificity were 33% and 71%, respectively. Sensitivity was lowest for suicidal ideation, self-dislike, guilt, and sense of failure, while specificity was lowest for negative body image, pessimism, and sadness. Indices independent of base rate indicated poor general agreement (median DOR = 1.80; median ICC = .30). This was especially true for symptoms that are more difficult to recognise such as sense of failure, self-dislike and guilt. Depression was detected with a sensitivity of 52% and a specificity of 69%. Distress was detected with a sensitivity of 64% and a specificity of 65%. Logistic regressions identified compassionate care, quality of relationship, and oncologist self-efficacy as predictors of patient-physician agreement, mainly on the less recognisable symptoms. Conclusions The results suggest that oncologists have difficulty accurately detecting depressive symptoms. Low levels of accuracy are problematic, considering that oncologists act as an important liaison to psychosocial services. This underlines the importance of using validated screening tests. Simple training focused on psychoeducation and relational skills would also allow for better detection of key depressive symptoms that are difficult to perceive.
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Affiliation(s)
- Lucie Gouveia
- Centre de recherche, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, H3T 1C5 Montreal, Qc Canada
| | - Sophie Lelorain
- Université de Lille, UFR de Psychologie, UDL, SCALab UMR 9193, Rue du Barreau, BP 60149, F-59653 Villeneuve d'Ascq cedex, France
| | - Anne Brédart
- Psycho-Oncology Unit, Institut Curie, 26 rue d'Ulm Cedex, 75248 Paris, France
| | - Sylvie Dolbeault
- Psycho-Oncology Unit, Institut Curie, 26 rue d'Ulm Cedex, 75248 Paris, France
| | - Angélique Bonnaud-Antignac
- Université de Nantes, UFR des Sciences Pharmaceutiques, Équipe de Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, 1 rue Gaston Veil, BP 53508, Nantes Cedex 1, 44035 France
| | - Florence Cousson-Gélie
- Institut régional du cancer, Pôle prévention Epidaure, Université Montpellier 3, 208 Avenue des Apothicaires, Montpellier Cedex 5, 34298 Montpellier, France
| | - Serge Sultan
- Centre de recherche, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, H3T 1C5 Montreal, Qc Canada
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Fasse L, Flahault C, Brédart A, Dolbeault S, Sultan S. Describing and understanding depression in spouses of cancer patients in palliative phase. Psychooncology 2015; 24:1131-7. [PMID: 25707938 DOI: 10.1002/pon.3777] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 12/21/2014] [Accepted: 01/24/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND The cancer patient's relatives and family constitute one of the patient's main sources of support throughout the disease. In recent years, several studies have emphasized the psychological vulnerability of spouses-caregivers with a high proportion suffering from anxiety and depression symptoms. The literature underlines several factors of detrimental outcomes but critical aspects of the spousal relationship as attachment were neglected. OBJECTIVES This study aims at (1) describing depressive symptoms and depression among spouses who care for palliative cancer patients and (2) highlighting important factors explaining these symptoms. METHODS We surveyed 60 spouses 1-6 months before the patient's death, (38 men, mean age: 62 years). RESULTS We found a high frequency of depression symptoms (25%) in the sample. Higher depression scores were associated to insecure-anxious attachment style, more frequent venting of emotion and disengagement through substance use. CONCLUSION Despite limitations, this description of caregivers' emotional adjustment in the palliative phase is unique. Future support programs could use the present information by focusing on emotional venting and avoidance. It also underlines the benefits for caregivers to develop organizational skills thanks to services that will lessen tasks or care responsibilities.
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Affiliation(s)
- Léonor Fasse
- Institut Gustave Roussy, 114 rue E. Vaillant, Villejuif, France.,Université Paris Descartes, LPPS EA 4057, IUPDP, Paris, France
| | - Cécile Flahault
- Université Paris Descartes, LPPS EA 4057, IUPDP, Paris, France.,Institut Curie, 26 rue d'Ulm, Paris, France
| | | | | | - Serge Sultan
- Université de Montréal & CHU Sainte-Justine, Montréal, Canada
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Brédart A, Kop JL, Efficace F, Beaudeau A, Brito T, Dolbeault S, Aaronson N. Quality of care in the oncology outpatient setting from patients' perspective: a systematic review of questionnaires' content and psychometric performance. Psychooncology 2014; 24:382-94. [DOI: 10.1002/pon.3661] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/17/2014] [Accepted: 08/01/2014] [Indexed: 11/09/2022]
Affiliation(s)
- A. Brédart
- Institut Curie; Paris France
- University Paris Descartes; Boulogne Billancourt France
| | - J.-L. Kop
- Inter-Psy; Lorraine University; Nancy France
| | - F. Efficace
- Health Outcomes Research Unit; Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center; Rome Italy
| | | | - T. Brito
- University Paris Descartes; Boulogne Billancourt France
| | - S. Dolbeault
- Institut Curie; Paris France
- Inserm U669; Paris
- Univ Paris-Sud and Univ Paris Descartes, UMR-S0669; Paris France
| | - N. Aaronson
- Division of Psychosocial Research and Epidemiology; The Netherlands Cancer Institute; Amsterdam The Netherlands
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Lelorain S, Brédart A, Dolbeault S, Cano A, Bonnaud-Antignac A, Cousson-Gélie F, Sultan S. How can we explain physician accuracy in assessing patient distress? A multilevel analysis in patients with advanced cancer. Patient Educ Couns 2014; 94:322-327. [PMID: 24315158 DOI: 10.1016/j.pec.2013.10.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/15/2013] [Accepted: 10/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine the determinants of the accuracy with which physicians assess metastatic cancer patient distress, also referred to as their empathic accuracy (EA). Hypothesized determinants were physician empathic attitude, self-efficacy in empathic skills, physician-perceived rapport with the patient, patient distress and patient expressive suppression. METHODS Twenty-eight physicians assessed their patients' distress level on the distress thermometer, while patients (N=201) independently rated their distress level on the same tool. EA was the difference between both scores in absolute value. Hypothesized determinants were assessed using self-reported questionnaires. Multilevel analyses were carried out. RESULTS Little of the variance in EA was explained by physician variables. EA was higher with higher levels of patient distress. Physician-perceived quality of rapport was positively associated with EA. However, for highly distressed patients, good rapport was associated with lower EA. Patient expressive suppression was also related to lower EA. CONCLUSION This study adds to the understanding of EA in oncological settings, particularly in challenging the common assumption that EA depends largely on physician characteristics or that better rapport would always favor higher EA. PRACTICE IMPLICATIONS Physicians should ask patients for feedback regarding their emotions. In parallel, patients should be prompted to express their concerns.
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Affiliation(s)
- Sophie Lelorain
- University of Lille Nord de France, Department of Psychology, Lille, France; UDL3, URECA, Villeneuve d'Ascq, France.
| | - Anne Brédart
- Institut Curie, Psycho-oncology Unit, Paris, France; Paris Descartes University, LPPS EA 4057 - IUPDP, Boulogne-Billancourt, France
| | - Sylvie Dolbeault
- Institut Curie, Psycho-oncology Unit, Paris, France; Inserm, U 669, Paris, France; Universtity of Paris-Sud and University of Paris Descartes, UMR-S0669, Paris, France
| | | | - Angélique Bonnaud-Antignac
- University of Nantes, EA4275 SPHERE 'bioStatistics, Pharmacoepidemiology and Human sciEnces Research', Nantes, France
| | - Florence Cousson-Gélie
- University of Montpellier 3, Laboratory Epsylon 'Dynamics of Human Abilities & Health Behaviors', Montpellier, France; ICM, Institut Régional du Cancer de Montpellier, Epidaure Prevention and Education Cancer Center, Montpellier, France
| | - Serge Sultan
- University of Montreal, Sainte Justine University Hospital Research Center, Montreal, Canada
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Dauchy S, Dolbeault S, Reich M, Barruel F, Le Bihan AS, Machavoine JL. Repérage et traitement de la dépression en cancérologie. PSYCHO-ONCOLOGIE 2013. [DOI: 10.1007/s11839-013-0438-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Fiszer C, Dolbeault S, Sultan S, Brédart A. Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psychooncology 2013; 23:361-74. [PMID: 24677334 DOI: 10.1002/pon.3432] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 09/16/2013] [Accepted: 09/18/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The assessment of supportive care needs is a crucial step in the development of appropriate interventions that may improve the quality of life of cancer patients. This review describes and analyzes the prevalence and predictors of the unmet supportive care needs of breast cancer (BC) patients and survivors and suggests paths for further research. METHOD Multiple databases were searched, considering only quantitative studies using validated needs assessment instruments and focusing uniquely on women diagnosed with BC. RESULTS Out of 761 hits, 23 studies answered to all eligibility criteria. Nineteen were cross-sectional, and the remaining four were longitudinal. Most included patients at different moments along the BC trajectory, from diagnosis to decades into survivorship, with the major proportion of patients under treatment. Only five concentrated on the posttreatment phase into extended survivorship. The concerns of women diagnosed with BC clustered around psychological and information needs, with the top concern being 'fear of the cancer returning'. Predictors of higher levels of needs included advanced disease stage, greater symptom burden, shorter time since diagnosis, higher levels of distress, and younger age. Prevalence differed between cultures with Asian women reporting greater information needs and lower psychological needs compared with Western women. CONCLUSIONS Revealing which needs BC patients consider most urgent and the factors related to greater needs will permit the development of improved and targeted supportive care. Future research should comprise longitudinal designs concentrating on women at specific moments along the BC trajectory for a dynamic understanding of these needs.
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Affiliation(s)
- Chavie Fiszer
- Laboratoire de Psychopathologie et Processus de Santé (LPPS EA 4057), IUPDP, Université Paris Descartes, Boulogne-Billancourt, France; Psycho-Oncology Unit/Supportive Care Department, Curie Institute, Paris, France
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Fasse L, Sultan S, Flahault C, MacKinnon CJ, Dolbeault S, Brédart A. How do researchers conceive of spousal grief after cancer? A systematic review of models used by researchers to study spousal grief in the cancer context. Psychooncology 2013; 23:131-42. [DOI: 10.1002/pon.3412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Léonor Fasse
- Institut Curie; Paris F-75006 France
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
| | - Serge Sultan
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
| | - Cécile Flahault
- Institut Curie; Paris F-75006 France
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
| | - Christopher J. MacKinnon
- Department of Educational and Counseling Psychology; McGill University; Montréal Québec Canada
- Palliative Care Research; SMBD Jewish General Hospital; Montréal Québec Canada
- Psychosocial Oncology Program; Montreal General Hospital; Montréal Québec Canada
| | - Sylvie Dolbeault
- Institut Curie; Paris F-75006 France
- Inserm, U 669; Paris France
- Université Paris-Sud and Université Paris Descartes; UMR-S0669; Paris France
| | - Anne Brédart
- Institut Curie; Paris F-75006 France
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
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Brédart A, Kop JL, Griesser AC, Fiszer C, Zaman K, Panes-Ruedin B, Jeanneret W, Delaloye JF, Zimmers S, Berthet V, Dolbeault S. Assessment of needs, health-related quality of life, and satisfaction with care in breast cancer patients to better target supportive care. Ann Oncol 2013; 24:2151-8. [DOI: 10.1093/annonc/mdt128] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Héquet D, Zarca K, Dolbeault S, Couturaud B, Ngô C, Fourchotte V, De La Rochefordière A, Féron JG, Fitoussi A, Bélichard C, Reyal F, Laki F, Hajage D, Sigal B, Asselain B, Alran S. Reasons of not having breast reconstruction: a historical cohort of 1937 breast cancer patients undergoing mastectomy. Springerplus 2013; 2:325. [PMID: 23961399 PMCID: PMC3733069 DOI: 10.1186/2193-1801-2-325] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 06/26/2013] [Indexed: 11/10/2022]
Abstract
Background The aims of the study were to investigate the factors associated with not having breast reconstruction following mastectomy and to assess patient satisfaction with information on reconstruction. Patients and methods We analysed a historical cohort of 1937 consecutive patients who underwent mastectomy at Institut Curie between January 2004 and February 2007. Their sociodemographic and clinicobiological characteristics were recorded in a prospective database. A questionnaire was sent to 10% of nonreconstructed patients. Results The proportion of patients with invasive cancer was 82.7%. The rate of nonreconstruction in patients with in situ and invasive cancer was 34.6% and 74.9%, respectively. On multivariate analysis, only employment outside the home was associated with reconstruction in patients with in situ cancer (p < 0.001). In patients with invasive cancer, employment status (p < 0.001) and smoking (p = 0.045) were associated with reconstruction, while age > 50, ASA score >1, radiotherapy (p < 0.0001) and metastatic status (p = 0.018) were associated with nonreconstruction. For 80% of questionnaire responders, nonreconstruction was a personal choice, mainly for the following reasons: refusal of further surgery, acceptance of body asymmetry, risk of complications and advanced age. Information on reconstruction was entirely unsatisfactory or inadequate for 62% of patients. Conclusion Better understanding the factors that influence decision of nonreconstruction can help us adapt the information to serve the patient’s personal needs.
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