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Fasse L, Roche N, Flahault C, Garrouste-Orgeas M, Ximenes M, Pages A, Evin A, Dauchy S, Scotte F, Le Provost JB, Blot F, Mateus C. The APSY-SED study: protocol of an observational, longitudinal, mixed methods and multicenter study exploring the psychological adjustment of relatives and healthcare providers of patients with cancer with continuous deep sedation until death. Palliat Care 2022; 21:217. [PMID: 36464684 PMCID: PMC9720978 DOI: 10.1186/s12904-022-01106-z] [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: 07/05/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Since 2016, France is the only country in the World where continuous deep sedation until death (CDSUD) is regulated by law. CDSUD serves as a response to refractory suffering in palliative situations where the patients' death is expected to occur in the following hours or days. Little is known on the psychological adjustment surrounding a CDSUD procedure for healthcare providers (HCPs) and relatives. Our study aims to gather qualitative and quantitative data on the specific processes behind the psychological adjustment of both relatives and HCPs, after the administration of CDSUD for patients with cancer. METHODS The APSY-SED study is a prospective, longitudinal, mixed-methods and multicenter study. Recruitment will involve any French-speaking adult cancer patient for who a CDSUD is discussed, their relatives and HCPs. We plan to include 150 patients, 150 relatives, and 50 HCPs. The evaluation criteria of this research are: 1/ Primary criterion: Psychological adjustment of relatives and HCPs 6 and 13 months after the death of the patient with cancer (psychological adjustment = intensity of anxiety, depression and grief reactions, CDSUD-related distress, job satisfaction, Professional Stress and Professional experience). Secondary criteria: a)occurrence of wish for a CDSUD in patients in palliative phase; b)occurrence of wish for hastened death in patients in palliative phase; c)potential predictors of adjustment assessed after the discussion concerning CDSUD as an option and before the setting of the CDSUD; d) Thematic analysis and narrative account of meaning-making process concerning the grief experience. DISCUSSION The APSY-SED study will be the first to investigate the psychological adjustment of HCPs and relatives in the context of a CDSUD procedure implemented according to French law. Gathering data on the grief process for relatives can help understand bereavement after CDSUD, and participate in the elaboration of specific tailored interventions to support HCPs and relatives. Empirical findings on CDSUD among patients with cancer in France could be compared with existing data in other countries and with results related to other medical fields where CDSUD is also conducted. TRIAL REGISTRATION This protocol received the National Registration Number: ID-RCB2021-A03042-39 on 14/12/2021.
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Affiliation(s)
- L. Fasse
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France ,grid.508487.60000 0004 7885 7602Institut de Psychologie Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 71 avenue E. Vaillant, F-92100 Boulogne- Billancourt, France
| | - N. Roche
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - C. Flahault
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France ,grid.508487.60000 0004 7885 7602Institut de Psychologie Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, 71 avenue E. Vaillant, F-92100 Boulogne- Billancourt, France
| | - M. Garrouste-Orgeas
- grid.508487.60000 0004 7885 7602IAME, INSERM, Université de Paris, F-75018 Paris, France ,Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France ,Medical unit, French British Hospital, Levallois-Perret, France
| | - M. Ximenes
- Maison Médicale Marie Galène, Bordeaux, France
| | - A. Pages
- grid.14925.3b0000 0001 2284 9388Biostatistical Unit, Gustave Roussy Hospital, Villejuif, France
| | - A. Evin
- grid.277151.70000 0004 0472 0371Palliative Care unit, CHU, Nantes, France
| | - S. Dauchy
- grid.508487.60000 0004 7885 7602DMU Psychiatry and Addictology, AP-HP.Centre, Université de Paris, Paris, France
| | - F. Scotte
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - JB. Le Provost
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - F. Blot
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France
| | - C. Mateus
- grid.14925.3b0000 0001 2284 9388DIOPP, Gustave Roussy Hospital, Villejuif, France
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Le Glaz A, Lemey C, Berrouiguet S, Walter M, Lemogne C, Flahault C. Physicians' and medical students' beliefs and attitudes toward psychotic disorders: A systematic review. J Psychosom Res 2022; 163:111054. [PMID: 36272378 DOI: 10.1016/j.jpsychores.2022.111054] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 10/02/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to analyze physicians' and medical students' (MS) beliefs and attitudes toward people with psychotic disorders. METHODS This systematic review follows the PRISMA guidelines. It was conducted on 5 databases (Pubmed, PsycINFO, Pascal & Francis, Scopus and EMBASE) with a keyword string combining words for physicians' and students' professional status, attitudes toward people, and psychotic disorders. No limitations on publication dates were imposed. RESULTS This review includes 39 articles, among which quantitative studies are in the majority, and general practioners are mainly represented. Schizophrenia is the main condition used to illustrate psychotic disorders and measure stigmatizing attitudes. Physicians' and MS' beliefs toward people with psychotic disorders are mainly represented by dangerousness and unpredictability. They can be reinforced with socio-demographic criteria (age and female gender) or physicians' beliefs about the disease's etiology. The desire for social distance is higher toward patients with schizophrenia compared to other psychiatric disorders, and medical care could be impacted with a tendency to refer them at psychiatric specific care or to anticipate their difficulties and to modify their treatment plan. Stigma scores remain globally high during medical training. Even if specific anti-stigma trainings have a positive impact on beliefs and attitudes, these effects do not last in time. CONCLUSION This review highlights the importance to explore physicians' and medical students' representations about patient with psychosis to understand better their difficulties in the management of these patients.
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Affiliation(s)
- A Le Glaz
- Brest Medical University Hospital, Université de Bretagne Occidentale, EA 7479 SPURBO, Brest, France.
| | - C Lemey
- Brest Medical University Hospital, Université de Bretagne Occidentale, EA 7479 SPURBO, Brest, France; IMT Atlantique, Lab-STICC, UMR CNRS 6285, F-29238, Brest, France.
| | - S Berrouiguet
- Brest Medical University Hospital, Université de Bretagne Occidentale, EA 7479 SPURBO, Brest, France; IMT Atlantique, Lab-STICC, UMR CNRS 6285, F-29238, Brest, France; TIM, INSERM, UMR 1101, Brest, France.
| | - M Walter
- Brest Medical University Hospital, Université de Bretagne Occidentale, EA 7479 SPURBO, Brest, France; IMT Atlantique, Lab-STICC, UMR CNRS 6285, F-29238, Brest, France.
| | - C Lemogne
- Department of Psychiatry and Addictology, AP-HP.Centre-Université de Paris, Paris, Île-de-France, France; Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France.
| | - C Flahault
- Université de Paris, LPPS, F-92100 Boulogne-Billancourt, France; U.F. de Psychologie et Psychiatrie de Liaison et d'Urgences DMU Psychiatrie et Addictologie, AP-HP Centre Université de Paris, France.
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Phan J, Laurence V, Marec-Berard P, Cordero C, Riberon C, Flahault C. La confrontation au deuil d’un pair chez une AJA atteinte de cancer. Une analyse phénoménologique interprétative. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0197] [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
Objectif : Les adolescents et jeunes adultes (AJA) atteints de cancer faisant face à la perte d’un autre AJA malade peuvent être confrontés à une « triple tâche » : le processus d’adolescence, l’ajustement psychologique au cancer et la mort d’un pair malade. L’objectif de l’étude a été d’explorer les processus sous-jacents à la perte d’un pair malade chez les AJA atteints de cancer.
Matériel et méthodes : Un entretien unique a été soumis à une Analyse phénoménologique interprétative (IPA), conçu pour comprendre le système de significations attaché à un phénomène subjectif et intime tel que le deuil.
Résultats : L’IPA a fait émerger six thèmes majeurs : le parcours de vie ; le parcours de soins ; les représentations du cancer, de soi et du monde ; l’ajustement psychologique au cancer ; les relations interpersonnelles ainsi que la perte d’un pair AJA malade. Le récit interprétatif montre la place centrale du processus d’identification aux pairs malades, notamment au défunt, dans la mise en sens du cancer et du deuil. Cette expérience du deuil d’un pair comporte des aspects négatifs (e.g., perspective de sa propre mort, perte de repère, peur de la rechute) et positifs (e.g., sentiment de continuité avec le défunt, changement de perception de soi et du monde).
Conclusion : L’étude montre l’importance de considérer ces processus dans l’accompagnement des AJA atteints de cancer confrontés à la mort d’un pair malade et de proposer des interventions adaptées à cette tranche d’âge.
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Le Glaz A, Lemey C, Walter M, Lemogne C, Flahault C. Oncologists’ beliefs about people with psychotic disorders : a qualitative study. Eur Psychiatry 2022. [PMCID: PMC9567565 DOI: 10.1192/j.eurpsy.2022.1697] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Cancer is the second major cause of death among people with psychotic disorders. With the same incidence, mortality in these patients remains higher than in the general population. As stigma has been identified as a risk factor for excess mortality, we focused on oncologists’ beliefs and attitudes towards people with psychotic disorders.
Objectives
The aim of this study was to uncover physicians’ representations about the impact of psychosis on oncological care.
Methods
In this qualitative study, individual semi-structured interviews were conducted with 20 physicians working in oncology in the University Hospital of Brest (France). Transcribed interviews were thematically analyzed. This study meets the COREQ criteria.
Results
Psychosis is described as a broad-spectrum condition whose severity ranges from the “mild” patient with imperceptible abnormality to the “severe” patient with cognitive and affective deficits. Oncologists identified behavioral and emotional symptoms which may modify the patient-physician relationship with difficulties to interact. Some of them consider that these patients are not interested in their health and will not get involved in oncological care. While the psychotic disorder is not considered as a limiting factor per se, oncologists felt concerned about being stigmatizing. They mentioned different aspects (like anticipation of non-compliance or inability to get help) that lead to changes in conventional treatment regimens and may result in a loss of opportunity.
Conclusions
Oncologists’ beliefs may lead to stigmatizing attitudes towards people with psychotic disorders who may not be given the best possible chances. Thus, these specific elements should be the basis for collaboration between psychiatrists and oncologists.
Disclosure
No significant relationships.
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Vander Haegen M, Flahault C, Lamore K. Parents d’un enfant atteint de cancer ou en rémission de cancer : une nécessité de les accompagner ! PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0215] [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: 11/21/2022]
Abstract
Lorsqu’un cancer touche un enfant, les parents (et la famille) se retrouvent impliqués à plusieurs niveaux dans la trajectoire de la maladie et des traitements. Cette trajectoire des soins est variable d’une famille à l’autre. Le monde psychomédical met depuis plusieurs années des actions sur le terrain pour accompagner les parents d’un enfant atteint de cancer ou en rémission de cancer. En tant que professionnels de santé, il nous faut poursuivre ces actions et développer un partenariat fort et harmonieux avec les parents, car ils sont les premiers relais pour le suivi médical de l’enfant.
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Stulz A, Favez N, Flahault C. Influence des facteurs individuels et dyadiques sur l’ajustement sexuel des couples lors d’un cancer du côlon. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0206] [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
Contexte : Le cancer du côlon est le troisième cancer le plus diagnostiqué au monde et a un impact sur tous les aspects de la vie des patients et de leur partenaire. Jusqu’à présent, peu d’études ont étudié l’ajustement sexuel des patients et aucune n’a analysé les interactions entre les partenaires.
Objectif : Décrire les facteurs individuels et dyadiques liés à l’ajustement sexuel des couples.
Méthode : Treize couples ont répondu à un ensemble de questionnaires portant sur le soutien social, la communication et les stratégies de coping dyadique et la satisfaction sexuelle. Des analyses non paramétriques ont été réalisées sur les données quantitatives.
Résultats : Le soutien social, la communication et les stratégies d’adaptation dyadique jouent un rôle dans l’ajustement sexuel des couples. La satisfaction ressentie par les patients et leurs partenaires quant au soutien conjugal est corrélée positivement à l’ajustement sexuel du patient. La qualité de la communication des patients quant au stress engendré par la maladie est liée à la satisfaction sexuelle des partenaires. Le coping dyadique de soutien comme la gestion commune du stress favorisent l’ajustement sexuel des patients et des partenaires. Ces stratégies démontrent l’importance de l’unité au sein du couple, le cancer étant abordé comme une « maladie du couple ». Cet engagement mutuel semble favoriser la satisfaction sexuelle des couples.
Conclusion : Gérer la maladie et le stress lié aux traitements en tant que couple et percevoir son partenaire comme une source de soutien satisfaisante est particulièrement bénéfique pour la satisfaction sexuelle des couples dont un membre est atteint d’un cancer du côlon.
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Flahault C, Bourgeois A, Soulié O. Se soucier des proches aidants de patients atteints de cancer ? Une réalité clinique à intégrer dans le parcours de soins en psycho-oncologie. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0219] [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: 11/23/2022]
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Jacob A, Hubert D, Grenet D, Brain C, Flahault C. P255 Parenthood experience of cystic fibrosis patients and their spouses. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01280-7] [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: 11/29/2022]
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Jacob A, Hubert D, Grenet D, Abdoul H, Flahault C. P358 How do cystic fibrosis patients experience parenthood? An explorative study. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30686-x] [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: 10/24/2022]
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Lamore K, Flahault C, Untas A. La communication conjugale après un diagnostic de cancer : exemples de couples confrontés à la mastectomie. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0025] [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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Robieux L, Zenasni F, Flahault C, Tavani JL. L’espoir dans la maladie chronique : représentations sociales de l’espoir chez les patients et soignants. Psychologie Française 2018. [DOI: 10.1016/j.psfr.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Dubois C, Seigneur E, Pacquement H, Laurence V, Brugières L, Flahault C. Cryopréservation de sperme chez les adolescents atteints de cancer — Partie II : Étude de l’expérience subjective rétrospective des patients. PSYCHO-ONCOLOGIE 2017. [DOI: 10.1007/s11839-017-0634-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Mathé J, Pagnat M, Flahault C. La fratrie face au cancer pédiatrique : état des lieux des connaissances de l’impact du cancer pédiatrique au regard du fonctionnement familial. PSYCHO-ONCOLOGIE 2015. [DOI: 10.1007/s11839-015-0532-4] [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: 11/27/2022]
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Fasse L, Sultan S, Flahault C. Expérience de pré-deuil à l’approche du décès de son conjoint : une analyse phénoménologique interprétative. Psychologie Française 2013. [DOI: 10.1016/j.psfr.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brédart A, Kop JL, Depauw A, Caron O, Sultan S, Leblond D, Fajac A, Buecher B, Gauthier-Villars M, Noguès C, Flahault C, Stoppa-Lyonnet D, Dolbeault S. Short-term psychological impact of the BRCA1/2 test result in women with breast cancer according to their perceived probability of genetic predisposition to cancer. Br J Cancer 2013; 108:1012-20. [PMID: 23462725 PMCID: PMC3619058 DOI: 10.1038/bjc.2012.599] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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] [Indexed: 01/01/2023] Open
Abstract
Background: The effect of BRCA1/2 gene test result on anxiety, depression, cancer-related thought intrusion or avoidance and perceived control over cancer risk was assessed in breast cancer (BC) patients, according to their perceived probability of genetic predisposition to cancer. Methods: Two hundred and forty-three (89% response rate) women with BC completed questionnaires after an initial genetic counselling visit (T1), of which 180 (66%) completed questionnaires again after receiving the BRCA1/2 results (T2). The discrepancy between women's perceived probability of cancer genetic predisposition at T1 and the geneticist's computed estimates was assessed. Results: In all, 74% of women received a negative uninformative (NU), 11% a positive BRCA1/2 and 15% an unclassified variant (UV) result. On hierarchical regression analysis, in women with a positive BRCA1/2 result (vs NU or UV), a lower perceived probability of cancer genetic predisposition than objective estimates at T1 predicted lower levels of anxiety at T2 (β=−0.28; P<0.01), whereas in women receiving a UV result (vs NU or positive BRCA1/2), a lower perceived probability of cancer genetic predisposition than objective estimates at T1 predicted higher levels of anxiety (β=0.20; P<0.01), depression (β=0.19; P<0.05) and intrusion (β=0.18; P<0.05) at T2. Conclusion: The type of BRCA1/2 test result differently affects distress according to women's perceived probability of genetic predisposition before testing.
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Affiliation(s)
- A Brédart
- Supportive Care Department, University Paris Descartes, Paris, France.
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Fasse L, Flahault C, Brédart A, Dolbeault S, Sultan S. Deuil et vulnérabilité psychique chez les personnes âgées. PSYCHO-ONCOLOGIE 2012. [DOI: 10.1007/s11839-012-0395-x] [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: 08/30/2023]
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Dolbeault S, Flahault C, Baffie A, Fromantin I. Psychological profile of patients with neglected malignant wounds: a qualitative exploratory study. J Wound Care 2010; 19:513-4, 516, 518-21. [DOI: 10.12968/jowc.2010.19.12.513] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Dolbeault
- Institut Curie, Paris, France
- Inserm, Paris, France
- Paris-Sud University and Paris Descartes University, Paris, France
| | - C. Flahault
- Institut Curie, Paris, France
- Laboratory of Health Psychology and Psychopathology, Paris V University, Paris, France
| | | | - I. Fromantin
- Institut Curie, Paris, France
- Laboratory of Health Psychology and Psychopathology, Paris V University, Paris, France
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Brédart A, Dolbeault S, Savignoni A, Besancenet C, This P, Flahault C, Falcou MC, Asselain B, Copel L. Session 3: Prévalence des difficultés sexuelles après le traitement d'un cancer du sein non métastatique et facteurs associés : une étude exploratoire réalisée à l'Institut Curie. Bull Cancer 2010. [DOI: 10.1016/s0007-4551(15)30912-7] [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: 11/26/2022]
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Brédart A, Dolbeault S, Savignoni A, Besancenet C, This P, Giami A, Michaels S, Flahault C, Falcou MC, Asselain B, Copel L. Prevalence and associated factors of sexual problems after early-stage breast cancer treatment: results of a French exploratory survey. Psychooncology 2010; 20:841-50. [PMID: 20568085 DOI: 10.1002/pon.1789] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 05/05/2010] [Accepted: 05/10/2010] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The objective of this study was to assess the prevalence and associated factors of sexual activity, sexual problems or sexual satisfaction in French early-stage breast cancer survivors (BCS). METHODS Eight hundred and fifty eligible, post-treatment (6 months-5 years) female patients, aged 18-70 years, randomly selected from a consultation list, were invited to fill in questionnaires exploring quality of life (EORTC QLQ-C30 and QLQ-BR23), body image scale, and sexuality (Sexual Activity Questionnaire-SAQ; Relationship and Sexuality Scale; French Sexual Behaviour Survey-CSF). RESULTS Fifty-three percent of BCS agreed to participate. Participating women (n=378) were younger, more often premenopausal at diagnosis and with a more recent diagnosis than non-respondents. The prevalence of sexual problems was significantly higher in BCS compared with adjusted data from a French female representative sample (p<0.0001). In logistic regression, no sexual activity (R(2) =0.37) or sexual dissatisfaction (R(2) =0.28) were associated with the feeling of emotional separation in the couple or of partner's fear of sexual intercourse, lower emotional functioning, poorer body image, or co-morbidities. In sexually active women (71% of respondents), lower frequency of sexual activity (R(2) =0.26), lower sexual pleasure (R(2) =0.22), or higher sexual discomfort (R(2) =0.22) were associated with the feeling of emotional separation in the couple or of partner's fear of sexual intercourse, lower emotional functioning, age (>50 years), nausea, or insomnia (all Hosmer-Lemeshow tests: p=NS). CONCLUSIONS Psychological factors including the perception of the couple relationship appeared prominent in BCS women's experience of sexual problems.
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Affiliation(s)
- Anne Brédart
- Psycho-Oncology Unit, Supportive Care Department, Institut Curie, Paris, France.
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Abstract
Cancer genetic counselling represents a very special situation of interaction between the geneticist and the counselee, marked by a number of specificities that account for its complexity. Cancer genetic counselling has multiple repercussions, such as identification of a deleterious genetic mutation associated with a high probability of developing breast and/or ovarian cancer, the implementation of preventive measures ranging from close surveillance to the decision to perform mutilating prophylactic surgical procedures, or the impact of the information on the other members of the counselee's family also concerned by the genetic risk. This chapter is based on a review of the literature that has been rapidly growing over recent years and on our clinical expertise as psycho-oncologists and geneticists. We will first present the reasons that make the information so critical. These reasons are both objective (complexity of the genetic information per se, difficulties of understanding the concept of risk) and subjective (information given to people with an emotionally charged family history and a perception of risks closely linked to their representation of cancer). At the same time, the counsellees are charged with the transmission of this information to members of their own family. We will then discuss the various modalities of communication in this setting. While unidirectional transfer of information from the geneticist to the counselee has been the preferred method in cancer genetics for a long time, a model based on patient-centered communication is more adequate in predictive medicine and allows shared decision making. In all cases, the different professionals involved in the process have to learn how to work in a performing cohesion. We also present the main guidelines on the subject and the various underlying objectives with regard to information delivery and the subject's personal experience. Although the psychological impact of genetic counselling consultations raises a number of questions, the results of preliminary studies are reassuring, demonstrating psychological benefits. However, a number of aspects concerning communication in predictive medicine remain to be investigated and improved.
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Affiliation(s)
- S Dolbeault
- Psycho-Oncology Unit, Institut Curie, Paris, France
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