Carole Bouleuc

Coping des patients atteints de cancer en phase palliative et communication médicale

Advanced cancer is likely to be perceived as a non-controllable source of stress for the individual. The patient distress at this stage of the illness and the strategies he uses to cope with it need to be explored so as physical symptoms, since they are correlated with quality of life at the end-of-life. But very few recent studies have considered patient coping and quality of life in the palliative stage of cancer. For patient at advanced stage of cancer, quality of life includes the quality of death, including being prepared to death, being informed about prognosis and receiving global care. For relatives, get medical information is a key point since uncertainty is often perceived as frightening. Patient coping strategies interact with those of the physician, who has to cope with different sources of stress. Taking into account these strategies among patients with advanced cancer could facilitate a medical communication respectful of the patients mental state, under the complex context of palliative care in oncology.

Adaptation en langue française d’un livret de questions à destination des patients atteints de cancer et de leurs proches, dans le cadre d’une consultation en soins de support et soins palliatifs en oncologie

Allowing cancer patients to actively participate by asking questions during the medical consultation has demonstrated that it improves care provision. In order to ease this behaviour, an Australian team developed and validated a question-prompt list (QPL). Our purpose is to present the French adaptation of this tool. Independently translated by three translators, a first version in French was submitted to a committee of ten specialists, oncologists and psycho-oncologists. We submit that second version to a sample of 10 patients in supportive and palliative care unit, including a meeting with a psychologist. Clinicians and patients were invited to comment on the clarity, relevance and acceptability of the QPL. These findings suggest that French patients assessed this QPL to be comprehensive and helpful to express their concerns.

La place du choix des patients concernant leur lieu de décès

Lorsqu’un patient atteint d’une maladie chronique incurable arrive a la phase ultime de sa vie, les soignants et ses proches se sentent souvent tres demunis devant l’impossibilite qu’ils ont de trouver une solution pour guerir le patient — ou au minimum pour ameliorer sa survie. Leurs priorites se recentrent alors le plus souvent sur deux objectifs: i) permettre au patient d’acceder a un confort maximal avec des traitements symptomatiques adaptes; ii) exaucer les souhaits du malade lorsqu’ils sont realistes. Selon une etude realisee en France en 2003, 57 % des personnes interrogees sur leur lieu de deces souhaite repondent a domicile (Beuzart, 2003). Cette enquete faite en population generale (pour des personnes a priori en bonne sante) est corroboree par les resultats retrouves aupres de patients suivis dans le cadre d’un reseau de soins palliatifs parisien (Ensemble) ou 60 % des patients expriment le souhait de deceder a domicile (21 % en hospitalisation et 19 % n’abordent pas le sujet) (Mauviel, 2005). Les recherches faites a l’etranger montrent des resultats relativement similaires: en Grande-Bretagne, jusqu’a 58 % des patients en phase terminale souhaitent deceder a domicile (Seale, 1994). Actuellement, seuls 26 % des Francais decedent a domicile et rarement dans le contexte d’une maladie chronique (Insee, 2000). Dans cet article, nous allons donc etudier successivement les facteurs qui peuvent participer au choix du lieu de fin de vie pour un patient cancereux dans le contexte francais actuel puis les facteurs pronostiques qui permettent a un patient ayant eu la possibilite de choisir le domicile de rester chez lui jusqu’a son deces.

Coping des patients atteints de cancer en phase palliative et communication médicaleCoping among patients with advanced cancer and medicalcommunication

Advanced cancer is likely to be perceived as a non-controllable source of stress for the individual. The patient distress at this stage of the illness and the strategies he uses to cope with it need to be explored so as physical symptoms, since they are correlated with quality of life at the end-of-life. But very few recent studies have considered patient coping and quality of life in the palliative stage of cancer. For patient at advanced stage of cancer, quality of life includes the quality of death, including being prepared to death, being informed about prognosis and receiving global care. For relatives, get medical information is a key point since uncertainty is often perceived as frightening. Patient coping strategies interact with those of the physician, who has to cope with different sources of stress. Taking into account these strategies among patients with advanced cancer could facilitate a medical communication respectful of the patients mental state, under the complex context of palliative care in oncology.

Adaptation en langue française d’un livret de questions à destination des patients atteints de cancer et de leurs proches, dans le cadre d’une consultation en soins de support et soins palliatifs en oncologieFrench adaptation of a question prompt list for cancer patients and their carers in supportive and palliative care

Allowing cancer patients to actively participate by asking questions during the medical consultation has demonstrated that it improves care provision. In order to ease this behaviour, an Australian team developed and validated a question-prompt list (QPL). Our purpose is to present the French adaptation of this tool. Independently translated by three translators, a first version in French was submitted to a committee of ten specialists, oncologists and psycho-oncologists. We submit that second version to a sample of 10 patients in supportive and palliative care unit, including a meeting with a psychologist. Clinicians and patients were invited to comment on the clarity, relevance and acceptability of the QPL. These findings suggest that French patients assessed this QPL to be comprehensive and helpful to express their concerns.