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Guastella V, Lambert C, Lafforgue A, Metretin P, Verstreate A, Watelet S, Perceau-Chambard É, Lautrette A. Withholding or withdrawing life-sustaining treatments in the COVID-19 pandemic: adherence to legal standards. BMJ Support Palliat Care 2023:spcare-2023-004504. [PMID: 37536752 DOI: 10.1136/spcare-2023-004504] [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: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES In France, when the patient is unable to express his wishes, the decision to withhold or withdraw life-sustaining treatment (WWLST) is made following a collegial procedure described by a law. The aim of our study was to assess how closely this WWLST decision-making procedure in end of life patients was maintained during the COVID-19 pandemic. METHODS This retrospective observational multicentre study compared the rate of non-compliance with WWLST decision-making procedures during the pandemic period from March to June 2020 with control period in 2019, in Clermont-Ferrand and Lyon Hospitals. Secondary objectives were to determine the factors associated with non-compliance. RESULTS In 430 deceased patients included (176 in 2019 and 254 in 2020), the rate of non-compliance was 61.4% in 2019 and 59.1% in 2020 (p=0.63). In multivariable analysis, non-compliance was associated with immunosuppression status (OR 1.69, 95% CI (1.12 to 2.54), p=0.01) but was lower in intensive care unit (OR 0.54, 95% CI (0.36 to 0.82), p=0.003) and when the patient had visits from relatives (OR 0.41, 95% CI (0.22 to 0.75), p=0.004). CONCLUSION In France, more than half of WWLST decisions do not comply with the law. The COVID-19 pandemic did not increase this non-compliance rate. Further studies are needed for a better understanding of the mechanisms underlying non-compliance with WWLST decision-making procedure. TRIAL REGISTRATION NUMBER NCT04452487.
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Affiliation(s)
- Virginie Guastella
- Palliative Care Departement, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Aurore Lafforgue
- Palliative Care Departement, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Pauline Metretin
- Palliative Care Departement, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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Garrouste-Orgeas M, Marché V, Pujol N, Michel D, Evin A, Fossez-Diaz V, Perruchio S, Vanbésien A, Verlaine C, Copel L, Kaczmarek W, Birkui de Francqueville L, Michonneau-Gandon V, de Larivière E, Poupardin C, Touzet L, Guastella V, Mathias C, Mhalla A, Bouquet G, Richard B, Gracia D, Bienfait F, Verliac V, Ranchou G, Kirsch S, Flahault C, Loiodice A, Bailly S, Ruckly S, Timsit JF. Incidence and risk factors of prolonged grief in relatives of patients with terminal cancer in French palliative care units: The Fami-Life multicenter cohort study. Palliat Support Care 2023:1-10. [PMID: 36878669 DOI: 10.1017/s1478951523000111] [Citation(s) in RCA: 1] [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] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Psychological consequences of grief among relatives are insufficiently known. We reported incidence of prolonged grief among relatives of deceased patients with cancer. METHODS Prospective cohort study of 611 relatives of 531 patients with cancer hospitalized for more than 72 hours and who died in 26 palliative care units was conducted. The primary outcome was prolonged grief in relatives 6 months after patient death, measured with the Inventory Complicated Grief (ICG > 25, range 0-76, a higher score indicates more severe symptoms) score. Secondary outcomes in relatives 6 months after patient death were anxiety and depression symptoms based on Hospital Anxiety and Depression Scale (HADS) score (range 0 [best]-42 [worst]), higher scores indicate more severe symptoms, minimally important difference 2.5. Post-traumatic stress disorder symptoms were defined by an Impact Event Scale-Revised score >22 (range 0-88, a higher score indicates more severe symptoms). RESULTS Among 611 included relatives, 608 (99.5%) completed the trial. At 6 months, significant ICG scores were reported by 32.7% relatives (199/608, 95% CI, 29.0-36.4). The median (interquartile range ICG score) was 20.0 (11.5-29.0). The incidence of HADS symptoms was 87.5% (95% CI, 84.8-90.2%) at Days 3-5 and 68.7% (95% CI, 65.0-72.4) 6 months after patient's death, with a median (interquartile range) difference of -4 (-10 to 0) between these 2 time points. Improvement in HADS anxiety and depression scores were reported by 62.5% (362/579) relatives. SIGNIFICANCE OF RESULTS These findings support the importance of screening relatives having risk factors of developing prolonged grief in the palliative unit and 6 months after patient's death.
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Affiliation(s)
- Maité Garrouste-Orgeas
- IAME, INSERM, Université de Paris, Paris, France
- Palliative Care Unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
- Medical Unit, French British Hospital, Levallois-Perret, France
| | | | - Nicolas Pujol
- Research Department Palliative Care Unit, Jeanne Garnier Institution, Paris, France
| | - Dominique Michel
- Palliative Care Unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
| | - Adrien Evin
- Palliative Care Unit, University Teaching Hospital, Nantes, France
| | | | | | | | | | - Laure Copel
- Palliative Care Unit, Diaconesses Croix Saint Simon Hospital, Paris, France
| | | | | | | | | | | | - Licia Touzet
- Palliative Care Unit, University Teaching Hospital, Lille, France
| | - Virginie Guastella
- Palliative Care Unit, University Teaching Hospital, Clermont Ferrand, France
| | - Carmen Mathias
- Palliative Care Unit, Mulhouse Sud Alsace Hospital Network, Mulhouse, France
| | - Alaa Mhalla
- Palliative Care Unit, Albert Chenevier Hospital, Créteil, France
| | | | - Bruno Richard
- Palliative Care Unit, University Teaching Hospital, Montpellier, France
| | - Dominique Gracia
- Palliative Care Unit, General Hospital, Salon-de-Provence, France
| | - Florent Bienfait
- Palliative Care Unit, University Teaching Hospital, Angers, France
| | - Virginie Verliac
- Palliative Care Unit, Saintonge General Hospital, Saintes, France
| | - Gaelle Ranchou
- Palliative Care Unit, General Hospital, Périgueux, France
| | - Sylvie Kirsch
- Palliative Care Unit, Bligny Hospital, Briis-Sous-Forges, France
| | - Cécile Flahault
- Laboratory of Psychopathology and Health Process, Paris University Paris, Boulogne-Billancourt, France
| | | | | | | | - Jean-François Timsit
- IAME, INSERM, Université de Paris, Paris, France
- Medical and infectious diseases ICU (MI2), APHP Bichat Hospital, Paris, France
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Marcolin ML, Tarot A, Lombardo V, Pereira B, Lander AV, Guastella V. The effects of foot reflexology on symptoms of discomfort in palliative care: a feasibility study. BMC Complement Med Ther 2023; 23:66. [PMID: 36855141 PMCID: PMC9971681 DOI: 10.1186/s12906-023-03873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/06/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND In palliative care, the relief of discomfort is sought by an overall approach, combining prescribed medication and additional therapies, such as foot reflexology (FR). The main objective of this study was to assess the feasibility of FR in a population of inpatients in a palliative care unit (PCU).The precariousness of the patients led us to perform a feasibility study and not a cohort study from the outset. Its secondary objective was to assess the impact of an FR session on some symptoms of discomfort (anxiety, pain, troubled sleep, and psychological distress). METHODS This is a feasibility study designed as a randomized controlled two-arm therapeutic trial. One arm tested FR, the other an active control, massage therapy (MT). The evaluators were blinded. RESULTS FR was feasible for 14 patients out of the 15 included in the FR group (95% CI [68%; 100%]). These patients were in the palliative care phase of cancer, motor neuron disease, or terminal organ failure. Concerning the symptoms of discomfort, ESAS sleep quality score was on average 3.9 (± 2.5) before a session in the FR group. It was improved to an average of 3 (± 2.3) on the day after the session (effect-size = 0.38 [0.03; 0.73]). CONCLUSION This study confirms the feasibility of an FR session for patients hospitalized in a PCU. It resulted in a slight improvement in sleep quality. For other discomfort symptoms such as anxiety, pain and distress, FR yielded a non-significant improvement. Significant results would have needed a larger cohort.
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Affiliation(s)
- Marie Lavarelo Marcolin
- grid.494717.80000000115480420Université de Clermont Auvergne, CHU Clermont-Ferrand, Palliative Care Center, 63001 Clermont-Ferrand, France
| | - Andréa Tarot
- grid.494717.80000000115480420Université de Clermont Auvergne, CHU Clermont-Ferrand, ACCePPT UCA, Palliative Care Center, 63001 Clermont-Ferrand, France
| | - Véronique Lombardo
- grid.494717.80000000115480420Université de Clermont Auvergne, CHU Clermont-Ferrand, Palliative Care Center, 63001 Clermont-Ferrand, France
| | - Bruno Pereira
- grid.494717.80000000115480420Université de Clermont Auvergne, CHU Clermont-Ferrand, Secteur Biométrie Et Médico-Économie, 63001 Clermont-Ferrand, France
| | - Axelle Van Lander
- grid.494717.80000000115480420Université de Clermont Auvergne, CHU Clermont-Ferrand, ACCePPT UCA, Palliative Care Center, 63001 Clermont-Ferrand, France
| | - Virginie Guastella
- Palliative Care Center, CHU Clermont-Ferrand, Clermont-Ferrand, France. .,Université de Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, 63001, Clermont-Ferrand, France.
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Van Lander A, Bioy A, Guastella V. Étude observationnelle des comportements familiaux durant la phase palliative terminale. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0196] [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
Accompagner l’entourage d’un patient atteint de maladie grave, évolutive ou terminale est une obligation légale (loi 99, art. L. 1er B) et nécessite des professionnels éclairés sur les mécanismes spécifiques. Objectif : découvrir les mécanismes psychoadaptatifs familiaux lors de la phase terminale. Méthode : la méthode était qualitative avec une observation participante dans un service de soins palliatifs entre 2016 et 2020. Résultats : l’observation de 649 familles révèle des détresses spécifiques, une relation soignante et/ou fusionnelle et un pacte dénégatif sur le mourir. L’absence de communication familiale sur le mourir est protectrice. Conclusion : les accompagnements doivent s’adapter aux fonctionnements de la famille. Elle est le berceau de la vie psychique du patient.
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Guastella V, Delorme J, Chenaf C, Authier N. The Prevalence of Off-label Prescribing of Transmucosal Immediate-Release Fentanyl in France. J Pain Symptom Manage 2022; 63:980-987. [PMID: 35192879 DOI: 10.1016/j.jpainsymman.2022.02.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/22/2022]
Abstract
CONTEXT The abuse of opioids and opioid-related harms, including deaths, in the United States are well documented. In the European Union, opioid use has also been increasing, particularly of fentanyl. OBJECTIVE We assessed the prevalence of off-label prescribing of transmucosal immediate-release fentanyl (TIRF), in France, in 2019. We looked at the patients' and prescribers' characteristics and compared the population of patients who received TIRF in off-label prescriptions with those taking it on-label. We also examined the differences between the patients with and without cancer in the off-label use population. METHODS This was a population-based cross-sectional study conducted in 2019, using the French national insurance claims database Système National d'Informations Inter-Régimes de l'Assurance Maladie, covering 98.8% of the French population, or 66 million people. RESULTS We selected 224,000 patients with fentanyl prescriptions. Among them, 23,209 had at least one TIRF delivered. The median age was 71 years (59-85) and most patients were female (55.8%). The prevalence of off-label prescribing of TIRF was 51.8% (n = 12,031), corresponding to 9827 patients not diagnosed with cancer. The three main pharmaceutical TIRF specialties prescribed in two groups were Abstral, Pecfent, and Instanyl. Overall, TIRF was mainly prescribed by private general practitioners (64.8%). CONCLUSION The prevalence of off-label prescribing of TIRF in France is extremely high. A field survey is now needed 1) to better understand why TIRF is used in conditions not indicated in its marketing authorization, and in what clinical situations, and 2) to determine whether the benefit/risk ratio of such use is favorable.
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Affiliation(s)
- Virginie Guastella
- Université de Clermont Auvergne (V.G.), CHU Clermont-Ferrand, Inserm, Neuro-Dol, Palliative Care Center, Clermont-Ferrand, France.
| | - Jessica Delorme
- Université de Clermont Auvergne (J.D., C.C., N.A.), CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service Pharmacologie médicale, Centres d'Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la douleur, Clermont-Ferrand, France; Observatoire français des Médicaments Antalgiques (OFMA/French Monitoring Centre for Analgesic Drugs) (J.D., C.C., N.A.), Université Clermont-Ferrand, Clermont-Ferrand, France; Institut Analgésia (J.D.), Faculté de Médecine, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université de Clermont Auvergne (J.D., C.C., N.A.), CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service Pharmacologie médicale, Centres d'Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la douleur, Clermont-Ferrand, France; Observatoire français des Médicaments Antalgiques (OFMA/French Monitoring Centre for Analgesic Drugs) (J.D., C.C., N.A.), Université Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas Authier
- Université de Clermont Auvergne (J.D., C.C., N.A.), CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service Pharmacologie médicale, Centres d'Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la douleur, Clermont-Ferrand, France; Observatoire français des Médicaments Antalgiques (OFMA/French Monitoring Centre for Analgesic Drugs) (J.D., C.C., N.A.), Université Clermont-Ferrand, Clermont-Ferrand, France; Observatoire français des Médicaments Antalgiques (OFMA/French Monitoring Centre for Analgesic Drugs (N.A.), Université Clermont-Ferrand, Clermont-Ferrand, France
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Preux C, Bertin M, Tarot A, Authier N, Pinol N, Brugnon D, Pereira B, Guastella V. Prevalence of Opioid Use Disorder among Patients with Cancer-Related Pain: A Systematic Review. J Clin Med 2022; 11:jcm11061594. [PMID: 35329919 PMCID: PMC8954099 DOI: 10.3390/jcm11061594] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 01/26/2022] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The opioid use disorder is an international public health problem. Over the past 20 years it has been the subject of numerous publications concerning patients treated for chronic pain other than cancer-related. Patients with cancer-related pain are also at risk of opioid use disorder. The primary objective of this literature review was to determine the prevalence of opioid use disorder in patients with cancer-related chronic pain. Its secondary objective was to identify the characteristics of these opioid users. METHODS This is a literature review of studies published over the last twenty years, from 1 January 2000 to 31 December 2020 identified by searching the three main medical databases: Pubmed, Cochrane, and Embase. A meta-analysis took account of between and within-study variability with the use of random-effects models estimated by the DerSimonian and Laird method. RESULTS The prevalence of opioid use disorder was 8% (1-20%) and of the risk of use disorder was 23.5% (19.5-27.8%) with I2 values of 97.8% and 88.7%, respectively. CONCLUSIONS Further studies are now needed on the prevalence of opioid use disorder in patients treated for cancer-related chronic pain. A screening scale adapted to this patient population is urgently needed.
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Affiliation(s)
- Céline Preux
- Palliative Care Center, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.P.); (M.B.); (A.T.); (D.B.)
| | - Marion Bertin
- Palliative Care Center, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.P.); (M.B.); (A.T.); (D.B.)
| | - Andréa Tarot
- Palliative Care Center, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.P.); (M.B.); (A.T.); (D.B.)
| | - Nicolas Authier
- Neuro-Dol, Service Pharmacologie Médicale, Centres d’Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Université de Clermont Auvergne, F-63001 Clermont-Ferrand, France;
- Institut Analgésia, Faculté de Médecine, BP38, F-63001 Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont-Ferrand, F-63001 Clermont-Ferrand, France
| | - Nathalie Pinol
- Centre de Documentation et Recherche de la Faculté de Médecine, CHU Clermont-Ferrand, Université de Clermont Auvergne, F-63000 Clermont-Ferrand, France;
| | - David Brugnon
- Palliative Care Center, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.P.); (M.B.); (A.T.); (D.B.)
| | - Bruno Pereira
- Unité de Biostatistiques, Direction de la Recherche Clinique et de l’Innovation, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France;
| | - Virginie Guastella
- Palliative Care Center, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; (C.P.); (M.B.); (A.T.); (D.B.)
- Neuro-Dol, Service Pharmacologie Médicale, Centres d’Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Université de Clermont Auvergne, F-63001 Clermont-Ferrand, France;
- Correspondence: ; Tel.: +33-46-7367-506960
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Tarot A, Delorme J, Authier N, Guastella V. [Opioid prescriptions in bone metastatic cancer patients: A cross sectional nationwide pharmacoepidemiological study]. Bull Cancer 2021; 108:1120-1125. [PMID: 34688483 DOI: 10.1016/j.bulcan.2021.08.006] [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: 03/22/2021] [Revised: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Oncological situations represent the majority of palliative situations. Labeling the palliative stage often comes too late in oncology. Pain comes first among discomfort symptoms with the greatest impact on quality of life. We wondered whether the evolutionary stage of the cancer was linked with the prescriptions of opioid analgesics. We observed the prescriptions of strong opioids in patients suffering from metastatic bone cancer 3 months before and after identifying the situation as palliative. This is a cross-sectional observational study performed between January 1, 2012 and December 31, 2016 using data from the French (nationwide claims database). We included 38,399 patients with cancer with at least one metastatic bone location in a palliative situation. Seventeen percent (n=6544) of patients had a prescription of opioid analgesics after palliative care labeling, 19.8 % (n=7606) had a prescription before, 31.1 % (n=11 949) had a prescription before and after and 32.0 % had no prescription of opioid analgesics. An increase in the dosage of opioid analgesics is observed between before and after labeling the stage of the disease as palliative with an average dosage ranging from 99.6 to 142.3mg per day. This study shows that labeling a situation as palliative affects prescriptions of strong opioid analgesics. An early identification of the situation as palliative is essential to provide appropriate care.
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Affiliation(s)
- Andréa Tarot
- CHU de Clermont-Ferrand, centre de soins palliatifs, 61, route de Châteaugay, 63118 Cébazat, France.
| | - Jessica Delorme
- CHU Clermont-Ferrand, université de Clermont Auvergne, centres d'addictovigilance et pharmacovigilance, centre évaluation et traitement de la douleur, délégation à la recherche clinique et à l'innovation, service pharmacologie médicale, Inserm, Neuro-Dol, 63001 Clermont-Ferrand, France; Institut Analgésia, faculté de médecine, BP38, 63001 Clermont-Ferrand, France
| | - Nicolas Authier
- CHU Clermont-Ferrand, université de Clermont Auvergne, centres d'addictovigilance et pharmacovigilance, centre évaluation et traitement de la douleur, délégation à la recherche clinique et à l'innovation, service pharmacologie médicale, Inserm, Neuro-Dol, 63001 Clermont-Ferrand, France; Institut Analgésia, faculté de médecine, BP38, 63001 Clermont-Ferrand, France; Observatoire français des médicaments antalgiques (OFMA/French Monitoring centre for analgesic drugs, université Clermont-Ferrand, 63001 Clermont-Ferrand, France
| | - Virginie Guastella
- CHU de Clermont-Ferrand, centre de soins palliatifs, 61, route de Châteaugay, 63118 Cébazat, France; CHU Clermont-Ferrand, université de Clermont Auvergne, centres d'addictovigilance et pharmacovigilance, centre évaluation et traitement de la douleur, délégation à la recherche clinique et à l'innovation, service pharmacologie médicale, Inserm, Neuro-Dol, 63001 Clermont-Ferrand, France
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Guastella V, Braud S. [Advocacy for food and wine in palliative care]. Rev Infirm 2021; 70:28-30. [PMID: 34565533 DOI: 10.1016/j.revinf.2021.07.007] [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: 06/13/2023]
Abstract
In the palliative care unit, the care and treatment provided are aimed at optimizing the quality of life and not the quantity of life. Food is adjusted to the patient's condition and is primarily oriented towards pleasure food.
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Affiliation(s)
- Virginie Guastella
- Centre de soins palliatifs de médecine, site Louise-Michel, CHU de Clermont-Ferrand, 61 route de Châteaugay, 63118 Cébazat, France.
| | - Sandrine Braud
- Centre de soins palliatifs de médecine, site Louise-Michel, CHU de Clermont-Ferrand, 61 route de Châteaugay, 63118 Cébazat, France
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Guastella V, Piwko G, Greil A, Lambert C, Lautrette A. The opinion of French pulmonologists and palliative care physicians on non-invasive ventilation during palliative sedation at end of life: a nationwide survey. BMC Palliat Care 2021; 20:68. [PMID: 34001065 PMCID: PMC8130279 DOI: 10.1186/s12904-021-00755-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deciding to withdraw non-invasive ventilation (NIV) at end-of-life (EOL) in patients with chronic respiratory failure is a challenge. The European Association for Palliative Care recommends not maintaining artificial therapies that could prolong life during palliative sedation (PS) at EOL. The aim of this survey was to assess palliative care physicians' and pulmonologists' opinion on withdrawing or maintaining NIV in patients with chronic respiratory failure during PS at EOL. METHODS From April to May 2019, we performed a prospective survey among pulmonologists (n = 1545) and palliative care physicians (n = 631) in France to determine the prevalence of opinion in favour of maintaining NIV and identify the factors associated with opinion in favour of withdrawing or maintaining NIV with multiple logistic regression. RESULTS A total of 457 participants were enrolled comprising 202 pulmonologists and 255 palliative care physicians. An opinion in favour of maintaining NIV was found in 88 (19.3 95%CI [15.7; 23.2]) physicians comprising 57 (28.2%) pulmonologists and 31 (12.2%) palliative care physicians (p < 0.001). The factors associated with an opinion in favour of maintaining NIV were spending time looking for advanced directives (AD) in the patient's file (odds ratio (OR): 6.54, 95%CI [2.00; 21.32], p = 0.002) and personal ethics of physicians (OR: 17.97, 95%CI [9.52; 33.89], p < 0.001). The factor associated with an opinion in favour of withdrawing NIV was palliative care training (OR: 0.31, 95%CI [0.16; 0.60], p < 0.001). The three main reasons in favour of maintaining NIV among the nine identified were emotional comfort for close relatives, reducing discomfort of dyspneoa and anticipation of suffocation. CONCLUSION In France, around 20% of pulmonologists and palliative care physicians declared an opinion in favour of maintaining NIV during PS at EOL because of their personal ethics and spending time looking for AD, if any, in the patient's file. Palliative care training can stimulate reflection help foster a change of opinion about practices, especially in the case of patients with NIV during PS at EOL.
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Affiliation(s)
- V. Guastella
- grid.411163.00000 0004 0639 4151Palliative Care Unit, Montpied Hospital, University Hospital of Clermont-Ferrand, 54 rue Montalembert, BP69, 63003 Clermont-Ferrand, Cedex 1, France
| | - G. Piwko
- grid.411163.00000 0004 0639 4151Pulmonology Unit, Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - A. Greil
- grid.411163.00000 0004 0639 4151Pulmonology Unit, Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - C. Lambert
- grid.411163.00000 0004 0639 4151Biostatistics unit (DRCI), Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - A. Lautrette
- grid.411163.00000 0004 0639 4151Medical Intensive Care, Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
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10
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Selvy M, Pereira B, Kerckhove N, Busserolles J, Farsi F, Guastella V, Merle P, Pezet D, Balayssac D. Prevention, diagnosis and management of chemotherapy-induced peripheral neuropathy: a cross-sectional study of French oncologists' professional practices. Support Care Cancer 2021; 29:4033-4043. [PMID: 33403401 DOI: 10.1007/s00520-020-05928-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is challenging for oncologists. Many publications mention the high incidence of CIPN and the lack of effective preventive/management strategies and robust diagnostic tools. This cross-sectional study was aimed at assessing the practice of French oncologists for CIPN prevention, diagnosis and management. METHODS This web-based survey was sent to French oncologists by the regional cancer networks. Incidence and impact of CIPN were assessed using visual analogue scales (VAS) and diagnostic strategies were recorded. Also recorded were the drugs used to prevent or manage CIPN and their perceived efficacy and safety (VAS). RESULTS Among the 210 oncologists included, the perceived incidence of CIPN was about 36.2 ± 22.1% of patients. About 99.5% of oncologists declared that they assess CIPN during medical follow-up. The use of drugs to prevent CIPN was reported by 9.6% of oncologists (group B vitamins (35.0%) and calcium and magnesium infusion (25.0%)). In the case of CIPN, the therapeutic adjustment of neurotoxic anticancer drugs is performed by 99.0% of oncologists (chemotherapy change (49.8%), dose reduction (30.9%) or interruption (19.3%)). The pharmacological management of CIPN was declared by 72.9% of oncologists. The main drugs used are pregabalin (75.8%), amitriptyline (32.7%) and gabapentin (25.5%). Duloxetine (ASCO recommendation) is used by only 11.8% of oncologists. CONCLUSION Oncologists were clearly aware of CIPN risks, but its incidence tended to be underestimated and the ASCO recommendations for the management of CIPN were not followed. The prevention, diagnosis and management of CIPN remain problematic in clinical practice in France. TRIAL REGISTRATION ClinicalTrials.gov : NCT03854864.
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Affiliation(s)
- Marie Selvy
- CHU Clermont-Ferrand, INSERM U1107 NEURO-DOL, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation de la recherche clinique et de l'innovation, Biostatistics Unit, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France
| | - Nicolas Kerckhove
- CHU Clermont-Ferrand, INSERM U1107 NEURO-DOL, Institut ANALGESIA, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Jérôme Busserolles
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Fadila Farsi
- Réseau Régional de Cancérologie ONCO-AURA, CRLCC Léon Bérard, F-69373, Lyon Cedex 08, France
| | - Virginie Guastella
- Service de soins palliatifs, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France
| | - Patrick Merle
- Service de Pneumologie, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France
| | - Denis Pezet
- INSERM U1071, M2iSH, USC-INRA 2018, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - David Balayssac
- CHU Clermont-Ferrand, INSERM U1107 NEURO-DOL, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France.
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11
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Smirdec M, Jourdain M, Guastella V, Lambert C, Richard JC, Argaud L, Jaber S, Klouche K, Medard A, Reignier J, Rigaud JP, Doise JM, Chabanne R, Souweine B, Bourenne J, Delmas J, Bertrand PM, Verdier P, Quenot JP, Aubron C, Eisenmann N, Asfar P, Fratani A, Dellamonica J, Terzi N, Constantin JM, Van Lander A, Guerin R, Pereira B, Lautrette A. Impact of advance directives on the variability between intensivists in the decisions to forgo life-sustaining treatment. Crit Care 2020; 24:672. [PMID: 33267904 PMCID: PMC7709386 DOI: 10.1186/s13054-020-03402-7] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is wide variability between intensivists in the decisions to forgo life-sustaining treatment (DFLST). Advance directives (ADs) allow patients to communicate their end-of-life wishes to physicians. We assessed whether ADs reduced variability in DFLSTs between intensivists. METHODS We conducted a multicenter, prospective, simulation study. Eight patients expressed their wishes in ADs after being informed about DFLSTs by an intensivist-investigator. The participating intensivists answered ten questions about the DFLSTs of each patient in two scenarios, referring to patients' characteristics without ADs (round 1) and then with (round 2). DFLST score ranged from 0 (no-DFLST) to 10 (DFLST for all questions). The main outcome was variability in DFLSTs between intensivists, expressed as relative standard deviation (RSD). RESULTS A total of 19,680 decisions made by 123 intensivists from 27 ICUs were analyzed. The DFLST score was higher with ADs than without (6.02 95% CI [5.85; 6.19] vs 4.92 95% CI [4.75; 5.10], p < 0.001). High inter-intensivist variability did not change with ADs (RSD: 0.56 (round 1) vs 0.46 (round 2), p = 0.84). Inter-intensivist agreement on DFLSTs was weak with ADs (intra-class correlation coefficient: 0.28). No factor associated with DFLSTs was identified. A qualitative analysis of ADs showed focus on end-of-life wills, unwanted things and fear of pain. CONCLUSIONS ADs increased the DFLST rate but did not reduce variability between the intensivists. In the decision-making process using ADs, the intensivist's decision took priority. Further research is needed to improve the matching of the physicians' decision with the patient's wishes. Trial registration ClinicalTrials.gov Identifier: NCT03013530. Registered 6 January 2017; https://clinicaltrials.gov/ct2/show/NCT03013530 .
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Affiliation(s)
- Margot Smirdec
- Department of Anaesthesiology and Critical Care Medicine, Estaing Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Mercé Jourdain
- INSERM U1190, CHU Lille, Department of Critical Care Medicine, Roger Salengro Hospital, Univ. Lille, 59000, Lille, France
| | - Virginie Guastella
- Palliative Care Unit, Louise Michel Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistics Unit (DRCI), University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Christophe Richard
- Medical Intensive Care Unit, La Croix Rousse Hospital, University Hospital of Lyon, Lyon, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Hospital, University Hospital of Lyon, Lyon, France
| | - Samir Jaber
- Department of Anaesthesiology and Critical Care Medicine, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Kada Klouche
- Medical Intensive Care Unit, Lapeyronnie Hospital, University Hospital of Montpellier, Montpellier, France
| | - Anne Medard
- Cardiac Surgery Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean Reignier
- Medical Intensive Care Unit, Hotel-Dieu Hospital, University Hospital of Nantes, Nantes, France
| | | | - Jean-Marc Doise
- Intensive Care Unit, Morey Hospital, Hospital of Chalon-Sur-Saône, Chalon-sur-Saône, France
| | - Russell Chabanne
- Neurocritical Care Unit, Department of Anaesthesiology and Critical Care Medicine, Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jeremy Bourenne
- Emergency Intensive Care Unit, La Timone Hospital, University Hospital of Marseille, Marseille, France
| | - Julie Delmas
- Intensive Care Unit, Puel Hospital, Hospital of Rodez, Rodez, France
| | | | | | - Jean-Pierre Quenot
- Medical Intensive Care Unit, Mitterrand Hospital, University Hospital of Dijon, Dijon, France
| | - Cecile Aubron
- Medical Intensive Care Unit, Centre Hospitalier Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Nathanael Eisenmann
- Intensive Care Unit, Centre Jean Perrin, 54 Rue Montalembert, BP69, 63003, Clermont-Ferrand, Cedex 1, France
| | - Pierre Asfar
- Medical Intensive Care Unit, Larrey Hospital, University Hospital of Angers, Angers, France
| | - Alexandre Fratani
- Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Saint-Louis Hospital, Assistance Publique Hopitaux de Paris, Paris, France
| | - Jean Dellamonica
- Medical Intensive Care Unit, l'Archet Hospital, University Hospital of Nice, Nice, France
| | - Nicolas Terzi
- Medical Intensive Care Unit, Michallon Hospital, University Hospital of Grenoble, Grenoble, France
| | - Jean-Michel Constantin
- GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Axelle Van Lander
- UPU ACCePPt, Université Clermont Auvergne, Clermont-Ferrand, France.,EA-481, Laboratoire de Neurosciences, UBFC, Besançon, France
| | - Renaud Guerin
- Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Estaing Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Lautrette
- Intensive Care Unit, Centre Jean Perrin, 54 Rue Montalembert, BP69, 63003, Clermont-Ferrand, Cedex 1, France. .,LMGE «Laboratoire Micro-Organismes: Génome Et Environnement», UMR CNRS 6023, Clermont-Auvergne University, Clermont-Ferrand, France. .,Intensive Care Medicine, Montpied Teaching Hospital, 54 Rue Montalembert, BP69, 63003, Clermont-Ferrand, Cedex 1, France.
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12
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Garrouste-Orgeas M, Flahault C, Poulain E, Evin A, Guirimand F, Fossez-Diaz V, Perruchio S, Verlaine C, Vanbésien A, Kaczmarek W, Birkui de Francqueville L, De Larivière E, Bouquet G, Copel L, Verliac V, Marché V, Mathias C, Gracia D, Mhalla A, Michonneau-Gandon V, Poupardin C, Touzet L, Ranchou G, Guastella V, Richard B, Bienfait F, Sonrier M, Michel D, Ruckly S, Bailly S, Timsit JF. The Fami-life study: protocol of a prospective observational multicenter mixed study of psychological consequences of grieving relatives in French palliative care units on behalf of the family research in palliative care (F.R.I.P.C research network). BMC Palliat Care 2019; 18:111. [PMID: 31818281 PMCID: PMC6902332 DOI: 10.1186/s12904-019-0496-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 11/22/2022] Open
Abstract
Background Grieving relatives can suffer from numerous consequences like anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, and prolonged grief. This study aims to assess the psychological consequences of grieving relatives after patients’ death in French palliative care units and their needs for support. Methods This is a prospective observational multicenter mixed study. Relatives of adult patients with a neoplasia expected to be hospitalized more than 72 h in a palliative care unit for end-of-life issues will be included within 48 h after patient admission. End-of-life issues are defined by the physician at patient admission. Relatives who are not able to have a phone call at 6-months are excluded. The primary outcome is the incidence of prolonged grief reaction defined by an ICG (Inventory Complicate Grief) > 25 (0 best-76 worst) at 6 months after patient’ death. Prespecified secondary outcomes are the risk factors of prolonged grief, anxiety and depression symptoms between day 3 and day 5 and at 6 months after patients’ death based on an Hospital Anxiety and Depression score (range 0–42) > 8 for each subscale (minimal clinically important difference: 2.5), post-traumatic stress disorder symptoms 6 months after patient’ death based on the Impact of Events Scale questionnaire (0 best-88 worst) score > 22, experience of relatives during palliative care based on the Fami-Life questionnaire, specifically built for the study. Between 6 and 12 months after the patient’s death, a phone interview with relatives with prolonged grief reactions will be planned by a psychologist to understand the complex system of grief. It will be analyzed with the Interpretative Phenomenological Analysis. We planned to enroll 500 patients and their close relatives assuming a 25% prolonged grief rate and a 6-month follow-up available in 60% of relatives. Discussion This study will be the first to report the psychological consequences of French relatives after a loss of a loved one in palliative care units. Evaluating relatives’ experiences can provide instrumental insights for means of improving support for relatives and evaluation of bereavement programs. Trial registration NCT03748225 registered on 11/19/2018. Recruiting patients.
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Affiliation(s)
- Maité Garrouste-Orgeas
- IAME, 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. .,Service de médecine interne, Hôpital Franco Britannique, 4 rue Kléber, 92 300, Levallois-Perret, France.
| | - Cécile Flahault
- Psychology laboratory and work process, Paris Descartes University, Paris, France
| | - Edith Poulain
- Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
| | - Adrien Evin
- Palliative Care unit, University Teaching Hospital, Nantes, France
| | - Frédéric Guirimand
- Palliative Care unit, Jeanne Garnier Institution, Paris, France.,UFR Simone VEIL - Santé, Versailles Saint Quentin en Yvelines University, Versailles, France
| | | | | | | | | | | | | | | | | | - Laure Copel
- Palliative Care unit, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Virginie Verliac
- Palliative Care unit, Saintonge General Hospital, Saintes, France
| | | | - Carmen Mathias
- Palliative Care unit, Mulhouse Sud Alsace Hospital Network, Mulhouse, France
| | - Dominique Gracia
- Palliative Care unit, General Hospital, Salon-de-Provence, France
| | - Alaa Mhalla
- Palliative Care unit, Albert Chenevier Hospital, Créteil, France
| | | | | | - Licia Touzet
- Palliative Care unit, University Teaching Hospital, Lille, France
| | - Gaelle Ranchou
- Palliative Care unit, General Hospital, Périgueux, France
| | - Virginie Guastella
- Palliative Care unit, University Teaching Hospital, Clermont Ferrand, France
| | - Bruno Richard
- Palliative Care unit, University Teaching Hospital, Montpellier, France
| | - Florent Bienfait
- Palliative Care unit, University Teaching Hospital, Angers, France
| | - Marie Sonrier
- Psychology laboratory and work process, Paris Descartes University, Paris, France
| | - Dominique Michel
- Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
| | | | - Sébastien Bailly
- INSERM, CHU Grenoble Alpes, Grenoble Alpes University, HP2, Grenoble, France
| | - Jean-François Timsit
- IAME, INSERM, Université de Paris, F-75018, Paris, France.,AP-HP, Bichat Hospital, Medical and infectious diseases ICU (MI2), F-75018, Paris, France
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13
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Tarot A, Van Lander A, Pereira B, Guastella V. Étude de la relation entre détresse et confusion mentale chez les patients en situation palliative (Relation entre détresse et confusion mentale en situation palliative). Médecine Palliative 2019. [DOI: 10.1016/j.medpal.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Van Lander A, Tarot A, Savanovitch C, Pereira B, Vennat B, Guastella V. Assessing the validity of the clinician-rated distress thermometer in palliative care. Palliat Care 2019; 18:81. [PMID: 31623591 PMCID: PMC6798346 DOI: 10.1186/s12904-019-0466-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 09/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background The distress of patients suffering from a terminal illness can lead to a state of despair and requests for euthanasia and assisted suicide. It is a major challenge for palliative care workers. The Distress Thermometer (DT) is recommended by the National Comprehensive Cancer Network as a means of more easily assessing distress. It is available as a Self-assessment reported Distress Thermometer, but for a wider use in palliative care it should also be implemented in the form of a clinician-reported outcome (clinRO). Clinicians need to rate patient’s distress when the patient is not able to do so (subject that cannot be addressed, defensive patient…). The primary aim of the quantitative study was to assess the validity of the Clinician-Rated Distress Thermometer in palliative care. Method The assessments were performed by teams working in three palliative care centres. The primary endpoint was concordance between the patient and clinicians’ responses via Lin’s concordance coefficient. Eligible patients were aged 18 years or older, suffering from a severe disease in the palliative phase, and with a sufficient level of awareness to consent to participate in the study. A total of 51 patients were recruited, 55% were male, with a mean age of 65.8 years [39–90 years]. Results Three hundred sixty-four clinician-Rated Distress Thermometer and 467 Self-Reported Distress Thermometer were performed. Only 364 of the 467 Self-Reported Distress Thermometer were used for the study, as investigators did not systematically ask the patient to give an account of his distress. Concordance between patient and clinician responses: The Lin’s concordance coefficient with a threshold (alpha) of 5% was 0.46 [0.38; 0.54]. At the first assessment, it was 0.61 [0.44; 0.79]. The Cohen’s kappa coefficient was 0.52, with a concordance rate of 79.6%. The sensitivity was 82.9% [66.4–93.4] and the specificity 71.4% [41.9–91.6]. Conclusion The first assessment gave the best results in terms of concordance between Clinician-Rated DT and Self-Reported DT. In the next assessments, the Clinician-Rated DT were less consistent with the patients’ Self-Reported DT.
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Affiliation(s)
- A Van Lander
- CHU Clermont-Ferrand, Unit of palliative care, Hôpital Louise Michel, 63118, cébazat, France. .,University Clermont Auvergne, ACCePPT, Place Henri Dunand, 63000, Clermont-Ferrand, France.
| | - A Tarot
- CHU Clermont-Ferrand, Unit of palliative care, Hôpital Louise Michel, 63118, cébazat, France
| | - C Savanovitch
- University Clermont Auvergne, ACCePPT, Place Henri Dunand, 63000, Clermont-Ferrand, France
| | - B Pereira
- CHU Clermont-Ferrand, DRCI, 63000, Clermont-Ferrand, France
| | - B Vennat
- University Clermont Auvergne, ACCePPT, Place Henri Dunand, 63000, Clermont-Ferrand, France
| | - V Guastella
- CHU Clermont-Ferrand, Unit of palliative care, Hôpital Louise Michel, 63118, cébazat, France
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15
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Kerckhove N, Collin A, Condé S, Chaleteix C, Pezet D, Balayssac D, Guastella V. [Chemotherapy-induced peripheral neuropathy: Symptomatology and epidemiology]. Bull Cancer 2018; 105:1020-1032. [PMID: 30244980 DOI: 10.1016/j.bulcan.2018.07.009] [Citation(s) in RCA: 6] [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: 09/25/2017] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 12/18/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is common with specific semiological characteristics. When CIPN appears, there are many difficulties in guaranteeing sustained treatment, especially with optimal protocol. Moreover, CIPN have bad repercussions on quality of life after cancer disease. In this article, we have achieved a current state of CIPN and try to report details about semiological characteristics and topography. We have also produced some epidemiological data. Nonetheless, we have not voluntarily introduced treatment because it will be the topic of further work.
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Affiliation(s)
- Nicolas Kerckhove
- Délégation à la recherche clinique et à l'innovation, CHU de Clermont-Ferrand, université Clermont-Auvergne, NEURO-DOL, Inserm U1107, 2, rue Braga, 63100 Clermont-Ferrand, France
| | - Aurore Collin
- Université Clermont-Auvergne, NEURO-DOL, Inserm U1107, 2, rue Braga, 63100 Clermont-Ferrand, France
| | - Sakhalé Condé
- CHU de Clermont-Ferrand, université Clermont-Auvergne, neurologie, NEURO-DOL, Inserm U1107, 2, rue Braga, 63100 Clermont-Ferrand, France
| | - Carine Chaleteix
- CHU de Clermont-Ferrand, hématologie clinique adulte, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - Denis Pezet
- CHU Clermont-Ferrand, université Clermont-Auvergne, chirurgie et oncologie digestive, Inserm U1071, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - David Balayssac
- Délégation à la recherche clinique et à l'innovation, CHU de Clermont-Ferrand, université Clermont-Auvergne, NEURO-DOL, Inserm U1107, 2, rue Braga, 63100 Clermont-Ferrand, France
| | - Virginie Guastella
- CHU de Clermont-Ferrand, centre de soins palliatifs, route de Chateaugay, 63118 Cébazat, France.
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Cornillon P, Loiseau S, Aublet-Cuvelier B, Guastella V. Reasons for transferral to emergency departments of terminally ill patients - a French descriptive and retrospective study. BMC Palliat Care 2016; 15:87. [PMID: 27769258 PMCID: PMC5073929 DOI: 10.1186/s12904-016-0155-y] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients under palliative care and in hospital-at-home services are frequently transferred to emergency departments. We set out to identify the reasons for these presentations to determine the proportion that might be avoidable. METHODS We conducted a retrospective study by assessment of patient files. We studied admissions to four emergency departments in an area of France (Puy-de-Dôme) between September 2011 and August 2013. Reasons for transfer and diagnostic conclusion by emergency doctors were noted. We collected date of admission, time spent, investigations and treatments performed and patients' outcomes after the medical conclusions. We also determined whether patients called the hospital-at-home service before going to the emergency department. From these data we discerned potentially avoidable and unavoidable consultations. RESULTS We identified 52 transfers of patients from home to emergency departments. The most frequent reasons were: generalized weakness (11 cases), social isolation (8 cases) and end of life (7 cases). For 58 % of presentations, the investigations and treatments performed did not require presentation to an emergency department; 34 % of patients returned home after the visit, 41 % remained for simple observation and 20 % remained to receive special care. Two patients died in the emergency department. In 86 % of cases, presentations occurred when primary care was less readily available, and patients called home care services in only 42 % of cases before going to emergency departments. CONCLUSIONS Half of the transfers to emergency departments were potentially avoidable for terminally ill patients in home care. To reduce this proportion we need to promote access to primary care, educate patients in hospital-at-home service and train care-givers and doctors in palliative medicine.
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Affiliation(s)
- Pierre Cornillon
- Department of Palliative Care, Centre hospitalier Universitaire, Hopital Nord, 63000 Clermont-Ferrand, France
| | | | - Bruno Aublet-Cuvelier
- Department of Palliative Care, Centre hospitalier Universitaire, Hopital Nord, 63000 Clermont-Ferrand, France
| | - Virginie Guastella
- Department of Palliative Care, Centre hospitalier Universitaire, Hopital Nord, 63000 Clermont-Ferrand, France
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17
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Guastella V, Raynaud N. [The "wine bar", or a different way of caring]. Rev Infirm 2016; 65:29-30. [PMID: 27063879 DOI: 10.1016/j.revinf.2016.01.010] [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: 06/05/2023]
Abstract
The "wine bar" in the palliative care unit of Clermont-Ferrand general hospital is an example of a different way of providing care. It defends the right of patients at the end of life to treat themselves and others. Acknowledging that life is present right up until the end, patients are invited to drink wine at mealtimes and caregivers are encouraged to learn the basics of oenology.
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Affiliation(s)
- Virginie Guastella
- CHU de Clermont-Ferrand, Centre de soins palliatifs, Hôpital Nord BP 20056, 63118 Cébazat, France.
| | - Nathalie Raynaud
- CHU de Clermont-Ferrand, Centre de soins palliatifs, Hôpital Nord BP 20056, 63118 Cébazat, France
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Dualé C, Sibaud F, Guastella V, Vallet L, Gimbert YA, Taheri H, Filaire M, Schoeffler P, Dubray C. Perioperative ketamine does not prevent chronic pain after thoracotomy. Eur J Pain 2012; 13:497-505. [DOI: 10.1016/j.ejpain.2008.06.013] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 06/16/2008] [Accepted: 06/30/2008] [Indexed: 01/17/2023]
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Dualé C, Guastella V, Morand D, Cardot JM, Aublet-Cuvelier B, Mulliez A, Schoeffler P, Escande G, Dubray C. Characteristics of the neuropathy induced by thoracotomy: a 4-month follow-up study with psychophysical examination. Clin J Pain 2011; 27:471-80. [PMID: 21368665 DOI: 10.1097/ajp.0b013e31820e12d4] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [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
OBJECTIVES To explore the role of neuropathy in persistent pain after thoracotomy, combining a clinical follow-up and a psychophysical examination of the operated area. METHODS Seventy-three patients were followed and examined at their discharge from hospital, 6 weeks and 4 months after pneumonectomy under thoracotomy. Spontaneous and evoked pain was assessed by clinical examination, a 7-day pain score, and the Neuropathic Pain Symptom Inventory. At the fourth month follow-up, pain and tolerance thresholds to pinprick, heat, and warm sensation threshold were measured on both sides of the thorax. RESULTS The rate of spontaneous pain was 40% at discharge and went up to 59% at the sixth week follow-up. Evoked pain was rare at discharge (11%), most cases appearing at the sixth week follow-up (47%). The evolution profiles of pain between the sixth week and the fourth month follow-up were heterogeneous with a tendency to decrease. Young age, female sex, and spontaneous pain observed at discharge from hospital were identified as early predictive factors of spontaneous pain persisting at the fourth month follow-up. On the side of operation, thresholds tended to increase for warm and hot stimuli, and to decrease for mechanical stimuli. At the fourth month follow-up, spontaneous pain and evoked pain were associated to static hyperalgesia, persisting hypoesthesia, low mechanical thresholds, altered sensation of heat, and impaired quality of life. DISCUSSION Peripheral neuropathy is common after thoracotomy, with variant characteristics, ranging from subclinical disturbances to severe pain. The process seems to develop between the discharge from hospital and the sixth week after thoracotomy.
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Affiliation(s)
- Christian Dualé
- CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation-SAMU-SMUR, Hôpital Gabriel-Montpied, Centre de Pharmacologie Clinique, CHU Clermont-Ferrand, France.
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Guastella V, Mick G, Soriano C, Vallet L, Escande G, Dubray C, Eschalier A. A prospective study of neuropathic pain induced by thoracotomy: Incidence, clinical description, and diagnosis. Pain 2011; 152:74-81. [PMID: 21075523 DOI: 10.1016/j.pain.2010.09.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 08/17/2010] [Accepted: 09/08/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Virginie Guastella
- CHU Clermont-Ferrand, Unité de Soins Palliatifs, Centre d'Evaluation et de Traitement de la Douleur, CIC 501, Service d'Anesthésiologie, Service de Chirurgie thoracique, Service de Pharmacologie, Clermont-Ferrand CEDEX, F-63003, France CHU Lyon, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Neurologique, LYON Cedex 4 F-69394, France CH Moulins, Unité de Traitement de la Douleur, F-03000 Moulins, France Clermont Université, Université d'Auvergne, UFR Médecine, Laboratoire de Pharmacologie, Clermont-Ferrand CEDEX 1 F-63001, France INSERM, UMR 766, UFR Médecine, Clermont-Ferrand CEDEX 1 F-63001, France
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Van Lander A, Guastella V, Dalle N. Psycho-oncologie et culture du mourir à domicile : l’appel à la pluridisciplinarité des médecins généralistes (MG). PSYCHO-ONCOLOGIE 2010. [DOI: 10.1007/s11839-010-0260-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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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