Rising to the medication's requirements: The experience of elderly cancer patients receiving palliative chemotherapy in the elective oncogeriatrics field.

A new subfield of oncology has emerged in the last twenty years to raise awareness and address the specific needs of elderly cancer patients, a population that was long neglected in oncology. We sought to understand the individual experiences, as well as moral and social implications of considering elderly cancer patients as "treatable". Following an anthropological critical interpretative approach focusing on practical and symbolic effects of chemotherapy in a rapidly evolving medical field, we conducted 20 semi-structured interviews and observations of medicine storage places at home among elderly cancer patients aged 70 and over in a clearly incurable situation receiving palliative chemotherapy. We used photographs representing paths as triggers in interviews, and compared the patients' views with those of 12 health professionals in oncology during a brief open-ended interview. Elderly cancer patients consider themselves to be survivors and fighters. Their long trajectory is a result of their successful struggle and tolerance of the treatments allowing them to carry on. They continually observe their physical ability and test their resistance, they resist complaining and are grateful to have cancer at a late stage of life. By highlighting their active life rather than the treatment inconveniences, they show they are "young elderly" persons, capable of keeping active physically. They are treated precisely because they demonstrated that they had the physical and moral capacity to take the hit of the chemotherapy to their bodies and had the will to fight. The development of oncogeriatrics has enabled the treatment of the fittest cancer patients over 70, but the ethical debate to treat some elderly patients and not others, and decisions of therapeutic abstention facing frail elderly cancer patients remains an issue rarely discussed. This aspect should not be eluded by the important progress achieved in medicine facing cancer.

[Oncology trajectories of elderly patients in a palliative situation : « The long and winding road ¼]. / Trajectoires oncologiques de personnes âgées en situation palliative: « The long and winding road ¼.

This paper focuses on trajectories of elderly patients with metastatic cancer who experience several lines of systemic palliative cancer treatments. Based on photographs representing paths, the representations between patients and professional caregivers vary. Where the latter see wearisome treatments and spaces of negotiation, the patients wish to be seen as fighters, a figure that ought to be adopted to face cancer and its treatments, day after day, to meet medical and social expectations.

Cet article s'intéresse aux trajectoires des personnes âgées atteintes de cancer métastatique qui font l'expérience de plusieurs lignes de traitements oncologiques systémiques palliatifs. Sur la base d'un choix de photos évoquant des parcours, les représentations entre les patients et les soignants diffèrent. Là où ces derniers voient la pénibilité des traitements et des espaces de négociation, les patients veulent être appréhendés comme des battants, figure qu'il convient d'adopter pour faire face au cancer et aux traitements, jour après jour, et correspondre aux attentes médicales et sociales.

[Interprofessional pill box management in an ambulatory care setting]. / Gérer un semainier a plusieurs chez un patient bénéficiaire de soins a domicile.

Complex multimorbid patients are now more common in ambulatory care and the management of their medication more frequently needs interprofessional collaboration. This qualitative study explored health professional's main challenges when introducing, preparing and sharing the use of a pill box for a patient. Another objective of this study was to explore options for improving care in these situations.

[Home care situations : discontinuity of trajectories]. / Situations de soins à domicile : discontinuité des trajectoires.

Introduction :The aging of the population in Western Europe led to a substantial increase of home-based care services. These services are quite simple in nature, but very complex to provide in the community. Little is known about how they are actually provided.Aim :By the mean of trajectory and arc of work analysis, the aim of this qualitative sociological study is to understand how support and care activities are ran in their local context.Method :Eight home care situations where observed during a period of three months, in three different home-based centers of one French speaking canton of Switzerland. Data collection included semi-structured and ethnographic interviews, service documents, key reference documents and observation of work practices in natural settings.Results :Data analysis showed that the standardization of evaluation practices - and a common frame of reference oriented by administrative principles - limited the possibility to problematize situations as a whole, from a caring point of view. As a consequence, services are mainly delivered in a fractionated way - and work organization is presently driven by compliance concerns.Conclusion :The ongoing standardization of care processes is a challenge to individualized and community-based care.

[The use of touch with a demented elderly resident: multifaceted evidence]. / Toucher un résident âgé atteint de démence: une évidence aux multiples facettes.

BACKGROUND: The use of touch and simple massage are first-line non-pharmacological interventions used in the comprehensive care for the elderly with dementia (EWD). CONTEXT: These acts have positive effects on both the level of anxiety and self-esteem of EWD. Nevertheless, they are not carried out by all caregivers in the same manner. OBJECTIVES: This study seeks to describe the representations of EWD's caregivers and their perceptions of practice of touch with this population. It will also highlight their ways of coping with any difficulties encountered. METHOD: It is based on a qualitative analysis of 31 semi-structured interviews (17 nurses and 14 health care assistants) conducted with caregivers working primarily with elderly patients with dementia. RESULTS: The results indicate that touch, although well integrated in all activities of personal care, is not considered as a care intervention in itself. It is subject to multiple influences. Indeed, on the one hand, the representations those caregivers have of the elderly patient with dementia overlap with those of their roles and skills and change the type of touch and their intentions when they touch. On the other hand, the emotions generated by the "dirty" work and the aggressiveness of the elderly patient with dementia sometimes make it difficult to touch them. DISCUSSION: The perspective of caregivers is essentially self-referenced and touch does not appear as an indicator of institutional norms.

[Going through chemotherapy: an age-revealing process]. / Vivre la chimiothérapie au quotidien: un processus qui révèle l'âge.

Elderly persons want to know about their diagnosis and therapeutic alternatives. Feeling in good health before as well as having gone through hard times enhance acceptability of chemotherapy. Possible issues are perceived in a limited but often overestimated lap of life. At this time, actual age is not present in the patient's mind. But as a result of the treatment, patients feel signs of ageing. The repercussions of the chemotherapy, mainly the tiredness, are withdrawal from social life and retreat into the private sphere. Cancer and chemotherapy give rise to a feeling of loneliness and vulnerability never known until this stage. Weakened by the experience, patients feel ageing. Transport difficulties and isolation are two significant consequences. Although patients claim to have taken the decision to be treated on their own, the investment of the closer relatives will prove to be essential during the chemotherapy. One cannot think about chemotherapy for elderly people without integrating psychosocial and economic dimensions from the outset. The geriatric evaluation must be seen as a dynamic approach likely to be modified by integrating new elements at any stage of the patient's treatment.

[Accepting chemotherapy at the age of 70 and over: between autonomy and ageing]. / Accepter une chimiothérapie à 70 ans et plus: entre autonomie et entrée dans la vieillesse.

This study is based on the interview of 21 subjects, aged 70 years and over, attending an oncology centre. At the end of their treatment, we have explored the processes of patient's choice, including goals, resources and constraints. The main variables influencing the acceptance of chemotherapy are full awareness of one's clinical condition, irrespective of whether a cure is possible or not, self perceived state of health, and lastly life expectancy. Age itself initially does not appear to be a limiting factor. Every effort should be made to tailor communication to individual needs, not least because of a link between learned and perceived treatment adverse effects. We found that symptoms, especially fatigue, hamper routine activities, leading to social withdrawal. Gradually the manifestations of the disease itself and of its treatment, combined with age, reveal both personal vulnerability and the role of support networks.

[Management and quality: in search of nursing]. / Cadres et qualité: à la recherche des soins infirmiers.

Quality management involves everyone in the hospital to a different degree. The head-nurses are key elements for the realization of these programs. Throughout this discussion regarding management, this article explores the links between quality management and nursing. The interviews conducted show that management has over-invested in quality. Therefore it will respond to problems concerning work organization and will also allow a professional acknowledgement. The analysis confirms that the quality values come before that of a pragmatic conception of health care based on a disjunctive viewpoint, both linear and timeless. Furthermore, because nursing is not considered as a discipline, quality healthcare remains undefined. The recommendations focus on the manager's role and particularity on the definition of the principal problems of different services.

[Elderly patients suffering from dementia in nursing homes: a daily challenge for nurses]. / Les personnes âgées atteintes de démence en établissement médico-social: défis quotidiens pour les soignantes.

In partnership with the EMS of French-speaking Valais, Switzerland, this study has brought to light certain characteristics in the care of elderly patients suffering from dementia. The interviews were conducted between two professional groups: 19 certified nurses' aides (CNA) and 19 registered nurses (RN). The medical facilities were investigated on the basis of psycho-sociological representations, time, professional security, interactions, the types of services offered, and work satisfaction. The CNAs confuse the depictions of aging and dementia, which corresponds to the belief of the general public. The RNs identify with a professional ideal which, as a consequence, fails to differentiate between the individuals who have been treated. These accounts give a reliable perspective for the two professions, but also serve as a screen for the diversity of situations involving elderly patients suffering from dementia. Concerning the time needed for the supplementary workload, the CNAs and RNs favor its efficiency, and the time needed is justified by the end results. The nurses' aides go about their work essentially on the basis of the tasks and services required by the institution, which is largely inspired by the hospital model. Confronted by the unconventional behavior of the residents suffering from dementia, the risk of assault results in deliberations for CNAs, whereas the unpredictability of the situations is fundamental for RNs. The lack of security measures is equally due to the shortcomings of the medical profession regarding dementia and the specific types of care required. These interactions, while regarded as essential by both CNAs and RNs, are not considered therapeutic, despite the fact that communication is a primary function! Both groups share the types of care offered. Ils limitations are chiefly in the area of satisfaction regarding psychological needs. This health-care project is better able to answer the needs of institutionalized patients rather than in providing individual attention. CNAs and RNs are said to be satisfied by their work with patients suffering from dementia with regards to its utility and professional ideal. In conclusion, the particulars of health care are first of all relative to the context (structure, make-up of personnel, type of residents), relying to a lesser degree on the kind of training obtained by the health care professionals.