Facteurs décisionnels limitant la démarche diagnostique ou thérapeutique en soins premiers chez le patient âgé : étude qualitative auprès de médecins généralistes

Abstract : Introduction: the aging of the population reveals problems in medical practice, to which general medicine must respond. This raises the question of a just and appropriate decision, in ethical and deontological terms. The doctor sometimes suggests to the patient that they not perform the additional tests usually recommended for their pathology. The purpose of this study was to determine the factors leading to this decision. Method: a qualitative study on general practitioners was performed. The data were collected by semi-directed individual interviews until saturation, then analysed by thematic analysis with post-encoding. Result: the sample includes 10 general practitioners. Factors limiting the diagnostic and therapeutic approach concern patient medical factors (altered general state, cognitive disorders, significant history, non-urgent and well-tolerated situation, degraded autonomy, advanced physiological age, limited life expectancy, palliative care situation, serious ongoing pathology), the will of the patient and their entourage, an unfavourable risk profile, relations with specialists, organisational limits, an unfavourable cost - benefit balance for a limited life expectancy, and ethical positioning. Interactions with the environment, the social situation, and the practitioners' knowledge of the patient can also intervene. Discussion: these results corroborate the results of previous studies. They could be supplemented by a quantitative study to better understand this decision-making process.
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Master Thesis
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Laura Covex. Facteurs décisionnels limitant la démarche diagnostique ou thérapeutique en soins premiers chez le patient âgé : étude qualitative auprès de médecins généralistes. Médecine humaine et pathologie. 2018. ⟨dumas-02060643⟩

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