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Robert R, Goldberg M. [Palliative care: Time to clarify the lexical field]. Rev Med Interne 2024; 45:61-64. [PMID: 38267321 DOI: 10.1016/j.revmed.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Affiliation(s)
- R Robert
- CIC Inserm 1402, médecine intensive réanimation, université de Poitiers, CHU de Poitiers, 86000 Poitiers, France.
| | - M Goldberg
- UMRi CNRS 7266, laboratoire littoral, environnement et sociétés, université de La Rochelle, 17000 La Rochelle, France.
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Prod'homme C, Macaire C, Chevalier L, Templier C, Mortier L. ["Hope for the best and prepare for the worst": A case of metastatic melanoma progressing under last line of immunotherapy]. Bull Cancer 2023; 110:978-981. [PMID: 37164772 DOI: 10.1016/j.bulcan.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Chloé Prod'homme
- Université Lille, ULR 2694-METRICS : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, clinique de médecine palliative, 59000 Lille, France.
| | - Camille Macaire
- Université Lille, Inserm U1189, CHU de Lille, service de dermatologie, 59000 Lille, France
| | - Luc Chevalier
- Université Lille, ULR 2694-METRICS : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, clinique de médecine palliative, 59000 Lille, France
| | - Carole Templier
- Université Lille, Inserm U1189, CHU de Lille, service de dermatologie, 59000 Lille, France
| | - Laurent Mortier
- Université Lille, Inserm U1189, CHU de Lille, service de dermatologie, 59000 Lille, France
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Blot F, Fasse L, Mateus C, Renard P, Verotte N, de Jesus A, Dumont SN. [Implementation of a multimodal strategy for information and collection of advance directives in a comprehensive cancer center]. Bull Cancer 2023:S0007-4551(23)00133-9. [PMID: 36963998 DOI: 10.1016/j.bulcan.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION In France, advance directives (AD) remain unknown and underused by healthcare users and professionals. This is particularly true in oncology. This work was carried out with patients and caregivers of a Comprehensive Cancer Center to improve their appropriation and information. METHODS The project, built by the Ethics Committee, the Patients Committee and the Palliative Care Team, made it possible to develop over 6 months a training program, an information procedure and several original documents. RESULTS A total of 34 one-hour training courses for all professionals were organized. A procedure for making information available, including the right to draft ADs, has been implemented. This procedure is personalized, gradual and multi-professional. When a patient wishes to write his AD, he is accompanied by a dedicated team and benefits from a specific form, which enlighten values and preferences before addressing the desired level of therapeutic commitment. Communication elements were diffused, and a specific training on "anticipated discussions" was created. A dedicated space in the computerized chart makes it possible to locate the existence of ADs and to display them instantaneously. DISCUSSION - CONCLUSION: Based on the observation of the obstacles to the use of ADs, the strategy we implemented aims to provide information that is both efficient and ethically respectful for both patients and caregivers. ADs are only one element facilitating autonomy and anticipation, and must be associated with a shared continuous definition of the project and of the goals of care.
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Affiliation(s)
- François Blot
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Réanimation, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France.
| | - Léonor Fasse
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Unité de psycho-oncologie, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Christine Mateus
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Équipe mobile de soins palliatifs, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Perrine Renard
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Équipe mobile de soins palliatifs, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Nelly Verotte
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Direction des affaires juridiques, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Anne de Jesus
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Direction de la qualité, relation avec les usagers, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Sarah N Dumont
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Département de médecine oncologique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
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Minot L, Conroy T, Salleron J, Henry A. [Examining the use of palliative systemic treatments near end-of-life for patients with metastatic cancer at a French cancer institute]. Bull Cancer 2023; 110:201-211. [PMID: 36462970 DOI: 10.1016/j.bulcan.2022.09.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Appropriate use of palliative systemic treatments near end-of-life is crucial to reduce aggressiveness of cancer care. The study's objective is to evaluate cancer quality-of-care near end-of-life in our cancer institute. METHODS From a retrospective cohort, we included all adults with metastatic solid cancers who died in 2019. The use of palliative systemic treatments close to death was measured from quality-of-care indicators described by Earle and al. The integration of supportive care into standard oncology care was also evaluated. All the information were collected from electronic records. RESULTS Of the 452 patients, 6.2% received systemic treatment in the last 14 days of life and 8.4% started a new systemic treatment in the last 30 days of life. Eighty six percent met a supportive care physician. This intervention was significantly less frequent in the TS≤14 group than in the TS>30 group (71.4 % vs 89.5 % p=0.021). The main reasons for first contact were pain (35 %), early palliative care (29 %) and then exclusive palliative care (17.5 %). CONCLUSION Our institute offers a good quality of end-of-life care for patients with metastatic solid cancers. However, improvements should be done regarding prognostic estimation and integration of palliative care.
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Affiliation(s)
- Lauriane Minot
- Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France.
| | - Thierry Conroy
- Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Julia Salleron
- Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Aline Henry
- Institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
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Henri B, Sirvain S, de Wazieres B, Bernard L, Gavazzi G, Forestier E, Fraisse T. [Survey on antibiotic prescription practices for palliative care terminally ill patients of 75 years old and more]. Rev Med Interne 2022; 43:589-595. [PMID: 36064626 DOI: 10.1016/j.revmed.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/25/2022] [Accepted: 08/24/2022] [Indexed: 11/20/2022]
Abstract
Infections commonly occur terminally ill oldest patients in palliative care and questioned about antimicrobial use. The aim of this study was to describe practitioners' habits. METHOD ancillary study on antibiotic modalities according to the setting of care from a national practices survey based on self administered questionnaire sent by e-mail in 2017. RESULTS 220 practitioners/327 used antibiotic, 136 worked in hospital department (52 geriatricians), 20 nursing home and 64 general practitioners (GP). GP declared less palliative care patients (6/year). The antibiotic goal was symptomatic relief for 181 (82.3%) without statistically significant difference between groups. GP (25%) were the group that most collected patient opinion for antibiotic prescription. Nursing home (23%) and GP (18%) reported more urinary tract symptoms than others (11.7%) (P=0.003). Geriatricians (59.6%) declared significantly less urinary analysis than GP (90%) (P=0.0009). 212 doctor (96.4%) faced side effect (SI): more allergic reaction and less administration difficulties than the other groups. The stop decision was collegially took (156, 70,9%) significantly more in hospital (121, 89%) than in community (25, 39.1%) (P<0.001). Patient wishes were noted by 30 (46.96%) only GP. CONCLUSION Even if practice and number of patients follow up differ from each place of care, doctors' intention in antibiotic use respect palliative care goal to relieve discomfort. It is hard to diagnose infection and complementary exam are scarce. A repeated individualized evaluation with patient, his surrounding and his medical referent participation, is mandatory to give a constant adapted level of care in every place of care.
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Affiliation(s)
- B Henri
- Post-urgences gériatriques, CHU Purpan, 31000 Toulouse, France
| | - S Sirvain
- Court séjour gériatrique, CH Alès-Cevennes, 811 avenue du Dr J goubert, 30100 Ales, France
| | - B de Wazieres
- Service de gériatrie, CHU Caremeau, 30000 Nimes, France
| | - L Bernard
- Service de Maladies Infectieuses, CHU Hôpitaux de Tours, 37000 Tours, France
| | - G Gavazzi
- Service Universitaire de Gériatrie Clinique, CHU de Grenoble, 38000 Grenoble, France
| | - E Forestier
- Service de maladies infectieuses, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France
| | - T Fraisse
- Court séjour gériatrique, CH Alès-Cevennes, 811 avenue du Dr J goubert, 30100 Ales, France.
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Moracchini J, Godard-Marceau A, Aubry R. [Study of representations of end-of-life platelet transfusion by its protagonists: Patients, nurses and hematologic oncologists]. Bull Cancer 2020; 107:1241-1251. [PMID: 33092818 DOI: 10.1016/j.bulcan.2020.08.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/07/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION End-of-life platelet transfusion practice in onco-hematology is subjective and depends on representations shared by patients, nurses and hematologists. This study aims to describe these representations of platelet transfusion in a context of a severe and advanced hematologic malignancy through the social representation of its protagonists. METHODS A qualitative study, using the associative network method and including three groups of 15 participants (patients with an advanced hematologic malignancy, regularly transfused in platelet concentrates; nurses and hematologic oncologists) from four hematology centers was conducted between February and April 2019. Analysis was carried out using IraMuTeQ software. RESULTS Patients expect platelet transfusion to have a direct beneficial impact on their health and highlight human relations. Nurses aim at the patient's well-being, in his or her individuality, and at respecting the transfusion protocol. Physicians seek to relieve symptoms by taking into account a multitude of decision-making factors. The textual clustering method, nuances those previous results and individualizes four different orientations, independent of groups: dependency, singularity, subjectivity and neutrality. DISCUSSION The perception of the social representations related to platelet transfusion at the end-of-life should make it possible to adapt the discourse to the preferred orientation of the speaker and could be an asset in goals of care discussion with patients as well as with teams in charge of palliative care.
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Affiliation(s)
- Julie Moracchini
- Centre hospitalier universitaire de Besançon, service d'hématologie, 2, boulevard Fleming, 25000 Besançon, France; Centre hospitalier universitaire de Besançon, centre d'investigation clinique, Inserm CIC1431, 2, place Saint-Jacques, 25030 Besançon cedex, France.
| | - Aurélie Godard-Marceau
- Centre hospitalier universitaire de Besançon, centre d'investigation clinique, Inserm CIC1431, 2, place Saint-Jacques, 25030 Besançon cedex, France
| | - Régis Aubry
- Centre hospitalier universitaire de Besançon, centre d'investigation clinique, Inserm CIC1431, 2, place Saint-Jacques, 25030 Besançon cedex, France; Centre hospitalier universitaire de Besançon, service de soins palliatifs, 2, boulevard Fleming, 25000 Besançon, France
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Prod'homme C. [Palliative care medical consultation in a hematology department. Feedback and critical reflection on a year of practice]. Bull Cancer 2020; 107:1118-1128. [PMID: 33059871 DOI: 10.1016/j.bulcan.2020.08.015] [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: 06/11/2020] [Revised: 07/29/2020] [Accepted: 08/29/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Patients with hematological malignancies have less access to palliative care than other cancer patients, and benefit from it later in the course of their disease, though symptom burden is just as heavy. METHODS We created a specialized outpatient palliative care consultation in the hematology department to improve the quality of patient management and enhance cooperation with hematologists. RESULTS We found that though patient characteristics and survival were extremely variable, they all had in common a need for symptom management and care coordination. As a result of the consultation, hematology teams called upon a specialized palliative care multidisciplinary team more often to meet patients hospitalized within their departments, and more patients with hematological malignancies hemopathies were hospitalized in palliative care units. DISCUSSION We describe the benefits that can be anticipated when collaboration increases between hematology and palliative care, including early on in the course of disease. It is now up to policy-makers to establish priorities regarding the allocation of health resources, in particular regarding end-of-life. This requires identifying patient needs, optimizing patient access to specialized palliative care, and improving the pertinence of palliative care interventions as they cannot be generalized.
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Affiliation(s)
- Chloé Prod'homme
- CHU de Lille, clinique de médecine palliative, université de Lille, CNRS, 2, avenue Oscar-Lambret, 59000 Lille, France; Université Catholique de Lille, centre d'éthique médical, faculté de médecine et de maïeutique de Lille, ETHICS (Experiment, Transhumanism, Human Interactions, Care and Society) - EA 7446, 46, rue du Port, 59000 Lille, France.
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Tanguy-Melac A, Denis P, Pestel L, Fagot-Campagna A, Gastaldi-Ménager C, Tuppin P. Intensity of care, expenditure, place and cause of death people with lung cancer in the year before their death: A French population based study. Bull Cancer 2020; 107:308-321. [PMID: 32035648 DOI: 10.1016/j.bulcan.2019.11.011] [Citation(s) in RCA: 4] [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: 07/28/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Health care utilization of people with lung cancer (LC) the last year of life, their causes of death and place of death and the associated expenditure have been poorly described together. Then we conducted an observational study. METHODS People with LC covered by the French health Insurance general scheme (77% of the population) who died in 2015 were identified in the national health data system, together with their health care utilization and, in 95% of cases, their causes of death. RESULTS A total of 22,899 individuals were included (mean age: 68 years, SD±11.4), 72% of whom died in short-stay hospitals (SSH), 4% in hospital-at-home, 8% in Rehab hospital, 2% in skilled nursing homes and 14% at home. One-half of these people had also a chronic respiratory tract disease and 18% another cancer. Hospital palliative care (HPC) was identified for 65% of people, but for only 9% prior to their end-of-life stay. During the last month of life, 49% of people had two or more SSH stays, 15% were admitted to an intensive care unit, 23% received a chemotherapy session (13% during the last 14 days). The main cause of death was cancer for 92% of individuals (LC for 82%) The mean expenditure during the last year of life was €43,329 per individual. DISCUSSION This study indicates high rates of intensive care unit admissions and chemotherapy during the last month of life and a SSH hospital-centered management with intensive use of HPC mainly during the end-of-life stay.
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Affiliation(s)
- Audrey Tanguy-Melac
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Pierre Denis
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Laurence Pestel
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Anne Fagot-Campagna
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Christelle Gastaldi-Ménager
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Philippe Tuppin
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France.
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Tanguy-Melac A, Lesuffleur T, Fagot-Campagna A, Gastaldi-Ménager C, Rébillard X, Tuppin P. Health care utilization by men with prostate cancer during the year before their death: A 2015 population-based study. Prog Urol 2019; 29:995-1006. [PMID: 31708329 DOI: 10.1016/j.purol.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To study the characteristics and health care utilization of men with prostate cancer (PCa) during their last year and last month of life, as these data have been rarely reported to date. SUBJECTS AND METHOD Men covered by the national health Insurance general scheme (77% of the French population) treated for PCa (2014-2015), who died in 2015 were identified in the national health data system, including reimbursed hospital and outpatient care, and their causes of death. RESULTS A total of 11,193 men (mean age: 81 years, SD: 9.6) were included. Almost 58% of these men died in a short-stay hospital (SSH), 4% died in hospital-at-home, 9% died in Rehab, 9% died in skilled nursing homes and 21% died at home. During the last year of life, almost all men were hospitalised at least once in SSH and 47% received hospital palliative care (HPC), immediately prior to death in 8% of cases. During the last month of life, 76% of men were hospitalised at least once in SSH, 43% attended an emergency department and 14% were admitted to intensive care, 7% received a chemotherapy session, and 24% received an antineoplastic agent dispensed by a retail pharmacy. Cancer was the main cause of death for 63% of men, corresponding to PCa in 40% of cases, and cardiovascular disease was the main cause of death for 13% of men with marked variations according to age, place of death, and use of HPC. The mean cost reimbursed per man during the last year of life was €38,750 (€48,601 including HPC). CONCLUSIONS In France, end-of-life management of men with PCa, regardless of the cause of death, is centered on SSH and HPC, essentially at the time of death. Certain indicators of end-of-life management were particular high. LEVEL OF EVIDENCE 4.
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Bertrand A, Marcault-Derouard A, Devaux Y, Bertrand Y, Bergeron C, Veyet V, Cervos M, Filion S, Goy F, Schell M. [Palliative care for children in onco-hematology: Role of a specific home-care team]. Bull Cancer 2018; 105:771-779. [PMID: 30251628 DOI: 10.1016/j.bulcan.2018.05.007] [Citation(s) in RCA: 2] [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: 08/09/2017] [Revised: 05/14/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVE Our home-care unit (HCU) is specialized for pediatric cancer patients and has a strong palliative care activity. We believe that the introduction of home-care services can influence the place of palliative care and of death as well as the length of hospitalization. We aimed at describing characteristics and care course of patients treated in our HCU, and tried to identify some factors contributing to home care at the end of life. DESIGN/METHODS We conducted a retrospective, observational, monocentric study about patients in pediatric onco-hematology, treated at least one day in our home-care unit, who died between July 1st 2013 and December 31st 2015. Statistical analysis was descriptive and analytic. RESULTS A total of 74 patients known by our HCU died during study period. Eight were excluded. Forty-three out of 66 patients died at home. During the last 3 months of life, oncology patients have significantly less classical hospitalization, when compared to hematology patients. The implication of general physicians (GP) and nurses and information given to the family increase the possibility for home death. No significant association was found between ages at death, distance between home and hospital, other life conditions and place of death. CONCLUSIONS Our HCU has a strong palliative care activity and a high rate of children dying at home. Good collaborations between our pediatric onco-hematology team and our HCU as well as between our HCU and caregivers optimize palliative care.
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Affiliation(s)
- Amandine Bertrand
- Centre Léon-Bérard, IHOPe, hospitalisation à domicile pédiatrique, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France.
| | - Anna Marcault-Derouard
- Centre Léon-Bérard, ERRSPP Rhône-Alpes, ESPPéRA, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Yves Devaux
- Centre Léon-Bérard, hospitalisation à domicile adulte, 28, rue Laennec, 69008 Lyon, France
| | - Yves Bertrand
- Hospices civils de Lyon, IHOPe, hématologie pédiatrique, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Christophe Bergeron
- Centre Léon-Bérard, IHOPe, oncologie pédiatrique, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Véronique Veyet
- Centre Léon-Bérard, IHOPe, hospitalisation à domicile pédiatrique, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Marie Cervos
- Centre Léon-Bérard, IHOPe, hospitalisation à domicile pédiatrique, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Shirley Filion
- Centre Léon-Bérard, ERRSPP Rhône-Alpes, ESPPéRA, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Florence Goy
- Centre Léon-Bérard, IHOPe, hospitalisation à domicile pédiatrique, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Matthias Schell
- Centre Léon-Bérard, IHOPe, hospitalisation à domicile pédiatrique, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France; Centre Léon-Bérard, ERRSPP Rhône-Alpes, ESPPéRA, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
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Toporski J, Jonveaux-Rivasseau T, Lamouille-Chevalier C. [End-of-life debate: Citizen's point of view about deep and continuous sedation]. Rev Med Interne 2017; 38:800-805. [PMID: 29102388 DOI: 10.1016/j.revmed.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Sedation in palliative care meets a precise definition and corresponds to a medical practice. We assessed the comprehension of this practice by the French population. METHOD In 2015, citizen expressed their views on the Claeys-Leonetti bill by means of a consultative forum made available on the Internet site of the National Assembly. The content of the messages filed, regarding the right to deep and continuous sedation until death was analyzed using the ALCESTE textual data analysis software, supplemented by a thematic analysis in order to identify the perception that Internet users had of this practice. RESULTS Among the 1819 Internet users who participated in the forum, 67 expressed their views as Health professionals, 25 of whom were directly involved in palliative care, as well as 10 sick persons. Analysis with the ALCESTE software highlighted two classes of statements. The first dealing with deep and continuous sedation, reflecting the specificity of the discourse of the Internet users. The second one consisted of textual units in which the modal verbs were dominant and overrepresented, thus providing information on the participants' perceptions. The thematic analysis highlighted four themes: death, intent, treatment and fear. CONCLUSION Deep and continuous sedation is perceived as a euthanasic practice or raises fear of such a drift. Provision of extended and accurate information to the population and health professionals is essential to ensure that this new model of sedation is integrated into the care of the terminally ill patients and their families.
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Affiliation(s)
- J Toporski
- Unité de soins palliatifs, centre Paul-Spillmann, 1, rue Foller, 54000 Nancy, France.
| | - T Jonveaux-Rivasseau
- Unité de soins palliatifs, centre Paul-Spillmann, 1, rue Foller, 54000 Nancy, France; Psychologie, groupe de recherche sur les communications (GRC), laboratoire interpsy EA 4432, université de Lorraine, BP 3397, 54000 Nancy, France
| | - C Lamouille-Chevalier
- Unité de soins palliatifs, centre Paul-Spillmann, 1, rue Foller, 54000 Nancy, France
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Sesé L, Didier M, Rousseau-Bussac G, Crequit P, Masanes MJ, Chouaid C. [Chemotherapy at the end of life for patients with lung cancer. A practice analysis]. Rev Mal Respir 2015; 32:256-61. [PMID: 25847203 DOI: 10.1016/j.rmr.2014.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/12/2014] [Indexed: 11/23/2022]
Abstract
RATIONALE Few studies have analyzed the aggressiveness of the care (continuation of active treatments) at the end of life in patients with lung cancer. The objective of this study was to assess practices in this setting in a university department of respiratory medicine. PATIENTS AND METHODS This retrospective study has consecutively included all patients who were managed for lung cancer and died over a period of 18 months. The analysis focused on the characteristics of the patients, the modalities of cancer treatment and the delays between the last active treatment and death. RESULTS The overall median survival of the 94 patients included was 9.6 months; 92% of patients having received at least one active treatment. During the 4 and 2 weeks periods preceding death, respectively 55% and 22% of the patients received active treatments. The median time between the last day of active treatment and death was 27 days. CONCLUSION These results, in concordance with the published data, showed that end of life active treatment in patients with lung cancer is a complex problem. We need prospective multicentric studies, with testing tools allowing better sharing of the decisions on active treatment between the medical team, the patient and his family.
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Dansin E, Lauridant G, Reich M, Villet S, Fournel P. [Reflections on the limits of specific treatments in thoracic oncology]. Rev Mal Respir 2015; 32:166-72. [PMID: 25765121 DOI: 10.1016/j.rmr.2014.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/12/2014] [Indexed: 11/23/2022]
Abstract
The modest impact of specific treatments is a major problem in oncology and particularly for metastatic lung cancer patients. Therapeutic progress achieved by some targeted therapies is, in fact, only relevant for a small proportion of patients. The vast majority of people with this condition are rapidly confronted by the limits of specific therapies and management is or becomes entirely palliative. This article addresses therapeutic limitations in the management of metastatic lung cancer, as well as legislative aspects and guidelines for practitioners when discussing these issues with patients, together with a discussion of the psychological consequences for patients.
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Chirac A, David G, Rieg N, Schott-Pethelaz AM, Bohe J, Carpentier F, Jacob X, Rhondali W, Filbet M. [Development of a tool for withholding and withdrawing life-sustaining treatment in the emergency room]. Ann Fr Anesth Reanim 2014; 33:555-62. [PMID: 25450728 DOI: 10.1016/j.annfar.2014.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/08/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Active treatment withholding and withdrawing decisions in the emergency room (ER) must be taken collegially according to ethical and juridical statements. Specific tools can support this process and our main goal was to create and validate such a tool. METHOD We created a first version of a tool to help for treatment withholding and withdrawing decisions inspired by similar documents from literature. Every item of this tool was then assessed by a group of experts (ER physicians and nurses) using the Delphi method to reach a consensus. RESULTS Thirty-four experts from eleven ER (academic, regional centre) were included and participate to the first round and twenty-seven to the second round. From the eighty-two-item tool, sixty-five items reach a consensus during these two rounds and were kept to constitute the final version of the tool. CONCLUSION We have been able to create a tool to help for treatment withholding and withdrawing decisions adapted to the guidelines for end of life patient's management in the ER. This tool has been validated using a Delphi method by a group of experts from different centres. This multicentre validation will help for the diffusion and use of this tool in the different ER of the Rhône-Alpes region.
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Affiliation(s)
- A Chirac
- Centre de soins palliatifs Pavillon 1K, CHU de Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Institut de psychologie, université de Lyon 2, 69500 Bron, France
| | - G David
- Structure des urgences du CHU de Grenoble, 38700 La Tronche, France
| | - N Rieg
- Structure des urgences du CHU de Lyon-Sud, 69495 Pierre-Bénite cedex, France
| | - A-M Schott-Pethelaz
- Information médicale évaluation recherche, hospices civils de Lyon, Lyon, France
| | - J Bohe
- Service de réanimation médicale, CHU de Lyon-Sud, hospices civils de Lyon, 69495 Pierre-Bénite cedex, France
| | - F Carpentier
- Structure des urgences du CHU de Grenoble, 38700 La Tronche, France
| | - X Jacob
- Structure des urgences du CHU de Lyon-Sud, 69495 Pierre-Bénite cedex, France
| | - W Rhondali
- Centre de soins palliatifs Pavillon 1K, CHU de Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - M Filbet
- Centre de soins palliatifs Pavillon 1K, CHU de Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
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Vernaz S, Casanova L, Blanc F, Lebel S, Ughetto F, Paut O. [To maintain or to withdraw life support? Variations on the methods of ending life in a pediatric intensive care unit over a period of 6 years]. ACTA ACUST UNITED AC 2014; 33:400-4. [PMID: 24907188 DOI: 10.1016/j.annfar.2014.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 04/05/2014] [Indexed: 11/16/2022]
Abstract
Since 2005, forgoing live-support (FLS) is allowed by the French law (known as the Leonetti law) for end-of-life patients only. This study aims at describing the variations over time in the use of the following methods to end life: FLS, brain death and cardiopulmonary resuscitation failure (CPR failure). It is a single retrospective study from 2007 to 2012. The Cochran-Armitage trend test is used in the statistical analysis. Over six years, 263 of the 5100 children who were hospitalized in our intensive care unit died, which represents a 5.2% mortality rate. FLS increased yearly from 31% of the deaths in 2007, to 71% in 2012 (P=0.0008). The rate of CPR failure decreased over the same period (P=0.0015). The rate of brain death remained constant. Following to the Leonetti law, FLS increase, and palliative cares develop without any increase of mortality.
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Affiliation(s)
- S Vernaz
- Service de réanimation pédiatrique, hôpital de la Timone, faculté de médecine, université Aix-Marseille, 27, boulevard Jean-Moulin, 13005 Marseille, France.
| | - L Casanova
- Département de médecine générale, Aix-Marseille université, 27, boulevard Jean-Moulin, 13005, Marseille, France
| | - F Blanc
- Service de réanimation pédiatrique, hôpital de la Timone, faculté de médecine, université Aix-Marseille, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - S Lebel
- Service de réanimation pédiatrique, hôpital de la Timone, faculté de médecine, université Aix-Marseille, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - F Ughetto
- Service de réanimation pédiatrique, hôpital de la Timone, faculté de médecine, université Aix-Marseille, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - O Paut
- Service de réanimation pédiatrique, hôpital de la Timone, faculté de médecine, université Aix-Marseille, 27, boulevard Jean-Moulin, 13005 Marseille, France
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Lonjaret L, Fourcade O, Roux FE, Beloucif S, Geeraerts T. Post-mortem cranioplasty: medical, ethical and religious considerations. ACTA ACUST UNITED AC 2014; 33:e99-e100. [PMID: 24836117 DOI: 10.1016/j.annfar.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Affiliation(s)
- L Lonjaret
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Équipe d'accueil "Modélisation de l'agression tissulaire et nociceptive", University Paul-Sabatier, hôpital Purpan, place du Dr-Baylac, 31000 Toulouse, France.
| | - O Fourcade
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Équipe d'accueil "Modélisation de l'agression tissulaire et nociceptive", University Paul-Sabatier, hôpital Purpan, place du Dr-Baylac, 31000 Toulouse, France.
| | - F-E Roux
- Department of Neurosurgery, University Hospital of Toulouse, University Paul-Sabatier, 31000 Toulouse, France.
| | - S Beloucif
- EA 4569, Department of Anesthesiology and Critical Care Medicine, université Paris 13, Sorbonne Paris-Cité, Avicenne University Hospital, 93000 Bobigny, France.
| | - T Geeraerts
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Équipe d'accueil "Modélisation de l'agression tissulaire et nociceptive", University Paul-Sabatier, hôpital Purpan, place du Dr-Baylac, 31000 Toulouse, France.
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