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Master Thesis

Étude de la consultation d’annonce en cancérologie pour les patients ayant un cancer incurable au diagnostic : information, place des traitements, et participation à la décision

Abstract : Despite considerable progress in the past decades that allowed many cancer patients to be cured, some patients are still considered as incurable today. Since the first cancer scheme, the announcement consultation in oncology, follows a specific outline. However no specific measure is included for patients who are considered incurable from diagnosis. More recently, the third cancer scheme promoted patient involvement in all decisions about him, reaffirming the concept of health democracy. The research performed during the Master 2 study is a preliminary work for a larger study focusing on whether the information and the manner in which it is given to incurable patients at diagnosis are related to the aggressiveness of the treatment they will receive. The main hypothesis for this study is that a low level of information, mainly focused on tumor treatment alongside poor patient involvement in decisions concerning him encourage aggressive therapies and might limit palliative care. The preliminary work, done during the Master 2 studies, explores announcements addressed to patients in order to estimate how information and tumor treatments are discussed and whether the patient is included in the decision process of the chosen treatment. A qualitative exploratory research was implemented between January and March 2018. It was based on audio recordings of announcement consultations for patients who had agreed on participating in the study as well as their oncologist. In order to capture practice variability, two different environments were studied: a University Teaching Hospital and a General Hospital. Ten physicians were solicited: seven in the University Teaching Hospital, three in the General Hospital. All of them agreed to participate in the study. Due to time constraint, the study finally included the four physicians who could be met first: three from a University Teaching Hospital, one from a General Hospital. Nine out of the ten patients that were met agreed to participate in the study, the one that refused mentioned being too distressed to take part in the study. The recordings concerning the first eight patients have been studied. The recording for the ninth patient could not be studied due to late inclusion. This first sample of consultation recordings allowed the description of intra- and inter- oncologists variability both in the content and the way of leading the consultation. However invariant topics could be noticed. On the one hand, the information delivered to the patient seems suboptimal and consists mainly in diagnostic information that the patient already knows. Little time is given to prognosis discussion. On the other hand, tumor treatment is overpowering and palliative care is rarely presented as an option of care management. As to patient involvement in decisions, it appears nonexistant in most of the consultations. Finally, it could be shown that the organisation and timing were stable and were unrelated to the physician, patient or type of hospital. The number of consultations that were studied is not sufficient to generalise those preliminary results. The study needs to be continued in University Teaching Hospitals, general hospitals as well as in private hospitals and specialised cancer care centers to allow a more thorough study of practice variability.
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Master Thesis
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Romain Seban. Étude de la consultation d’annonce en cancérologie pour les patients ayant un cancer incurable au diagnostic : information, place des traitements, et participation à la décision. Ethique. 2018. ⟨dumas-01864908⟩

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