André Stillmunkés

French general practitioners’ sense of isolation in the management of elderly cancer patients

BACKGROUND Cancer care in people over 75 years of age is particularly complex and requires collaboration between oncologists, geriatricians, GPs and other professional and family carers. To improve the care pathways for elderly people living with cancer, the French health authorities have created a network of oncologists and geriatricians; however, GPs experience difficulties in establishing their place in this network. OBJECTIVE This study aimed to analyse the impressions of French GPs involved in the care of elderly patients with cancer, including their feelings regarding their relationships with their oncologist and geriatrician colleagues. METHODS A qualitative approach using focus groups was employed. The proceedings of these focus groups were recorded, retranscribed and subjected to thematic analysis. RESULTS Although heavily involved in the care of their elderly patients living with cancer, the GPs who participated reported feeling isolated in their role at each step during the course of the disease. The principal themes addressed were screening and diagnosis, therapeutic decisions, multidisciplinary consultation meetings, the announcement of the diagnosis and monitoring at home. Their relationships with their oncologist colleagues showed much room for improvement, and they were unaware of the oncogeriatric network. CONCLUSIONS Improving the communication between GPs, oncologists and geriatric medicine seems to be one response to the isolation that GPs feel when caring for older people with cancer. At the primary care level, integration of GPs into the oncogeriatric network and the creation of a cancer care communication system in collaboration with the relevant hospital teams may be effective solutions.

Reliability and validity of the script concordance test for postgraduate students of general practice

Abstract Background: The script concordance test (SCT) is a validated method of examining students’ clinical reasoning. Medical students’ professional skills are assessed during their postgraduate years as they study for a specialist qualification in general practice. However, no specific provision is made for assessing their clinical reasoning during their postgraduate study. Objective: The aim was to demonstrate the reliability and validity of the SCT in general practice and to determine if this tool could be used to assess medical students’ progress in acquiring clinical reasoning. Methods: A 135-question SCT was administered to postgraduate medical students at the beginning of their first year of specialized training in general practice, and then every six months throughout their three-year training, as well as to a reference panel of 20 expert general practitioners. For score calculation, we used the combined scoring method as the calculator made available by the University of Montreal’s School of Medicine in Canada. For the validity, student’ scores were compared with experts, p <.05 was considered statistically significant. Results: Ninety students completed all six assessments. The experts’ mean score (76.7/100) was significantly higher than the students’ score across all assessments (p <.001), with a Cronbach’s alpha value of over 0.65 for all assessments. Conclusion: The SCT was found to be reliable and capable of discriminating between students and experts, demonstrating that this test is a valid tool for assessing clinical reasoning skills in general practice.

L'aménagement du domicile des personnes âgées est-il bénéfique ? Une revue systématique de la littérature

Among 920 papers which were found and evaluated according to CONSORT grid, 16 trials and 4 meta-analyzes were included in this review. Home adjustment is effective in the prevention of falls for patients with severe visual impairment (high level of evidence) and among fallers (intermediate level). It is beneficial in preserving the autonomy in patients with a loss of autonomy (intermediate level of evidence). In all these situations, the beneficial interventions are conducted by an occupational therapist. Further studies are needed to clarify the risk-benefit on other criteria (mortality, independence, quality of life) and other patient populations such as those with Alzheimer disease or at high risk for falls. The adjustments made by other carers than occupational therapists remain to be evaluated.