ABSTRACT
Background: Oral anticoagulants generate a burden of care that can affect the patient's quality of life. The concept of treatment's burden measures the impact of medical care for the patient's quality of life. Various factors can exacerbate the burden. Several studies have assessed the satisfaction of patients treated with oral anticoagulants. Objective: This study has assessed the burden of patients treated with oral anticoagulants. Methods: An analytical cross-sectional study of patients recruited from pharmacies in the Loire. A questionnaire was carried out using the anti-clot treatment scale, assessing satisfaction, and the Zarit scale, assessing the burden on carers of demented patients. Results: Anticoagulants were a burden for 41% (n = 158) of the 389 responding patients. Anticoagulants' burden was higher when oral anticoagulant was responsible for side effects, anxiety or lifestyle changes. Conclusion: The patients could be satisfied with the benefit of the treatment, satisfied with its practical modalities, and describe modifications of lifestyle habits contributing to the burden of the treatment.
Introduction: Les anticoagulants oraux génèrent une charge de soins pouvant impacter la qualité de vie des patients. Le fardeau du traitement mesure l'impact de la prise en charge médicale sur la qualité de vie. Des facteurs divers peuvent aggraver le fardeau. Plusieurs études ont évalué la satisfaction des patients traités par anticoagulants oraux. Objectif: Cette étude a évalué le fardeau des patients traités par anticoagulants oraux. Méthode: Étude transversale analytique menée auprès de patients recrutés dans des pharmacies ligériennes. Un questionnaire a été réalisé à partir de l'échelle échelle anti-clot treatment scale évaluant la satisfaction et de l'échelle Zarit évaluant le fardeau des aidants de patients déments. Résultats: Les anticoagulants étaient un fardeau pour 41 % (n = 158) des 389 répondants. Le fardeau des anticoagulants était plus important lorsque l'AO était responsable d'effets secondaires, d'angoisse ou modifiait leurs habitudes de vie. Conclusion: Les patients interrogés pouvaient être convaincus du bénéfice du traitement, satisfaits de ses modalités pratiques, et décrire un fardeau du traitement.
Subject(s)
Atrial Fibrillation , Humans , Atrial Fibrillation/drug therapy , Quality of Life , Cross-Sectional Studies , Anticoagulants/adverse effects , Surveys and Questionnaires , Administration, OralABSTRACT
BACKGROUND: Since the revision of the french law in 2016, artificial hydration is considered as a treatment and its withdrawal is part of the fight against extraordinary treatment at the end of life. Given its symbolism, the decision of withdrawal can be difficult for the patient, his or her entourage, and caregivers. The objective of this study was to assess the benefits and risks associated with artificial hydration (AH) at the end of life and the existing means of communication around this decision. METHOD: Systematic review of the literature from the Pubmed® search engine, between 2011 and 2021, in French or English by four researchers. RESULTS: Among the 102 articles identified, the eleven studies included were in favor of no effect of AH on the quality and duration of survival. A reduction in AH appeared to reduce symptoms related to fluid overload and may be related to better quality of end of life or dying. Dry mouth was the most recurrent discomfort associated with AH reduction or discontinuation. Regular mouth care could prevent this discomfort. A clinical trial with patient education seemed to increase indecision about stopping AH. CONCLUSION: Despite the lack of good quality studies, the benefit-risk balance of AH does not seem to favour its continuation. Communication tools such as videos or multidisciplinary programs could reduce the decisional conflict of patients, their families and caregivers.
Subject(s)
Terminal Care , Caregivers , Communication , Death , Female , Fluid Therapy/adverse effects , Humans , MaleABSTRACT
Vaccine hesitancy (VH) is defined as "delaying or refusing a secure vaccine despite its availability". This hesitancy affects caregivers and more specifically nurses. The purpose of this study is to assess determinants of influenza VH in the nurse's community. We conducted a systematic review of qualitative literature according to criteria of Preferred Reporting Items for Systematic Review and Meta-Analysis and Enhancing Transparency in Reporting the synthesis of Qualitative Research from 2009 until October 2020. Eleven qualitative studies analysed (ten thematic content analyses and one grounded theory method) found three main factors in VH. The first determinant was the benefit-risk equation considered as unfavourable due to an ineffective vaccine and fears about adverse effects as the pain of the injection. Wrong immunological beliefs brought into hesitancy. Disease barriers (hand washing and masks) and personal immunity were regarded as more effective than the vaccine. Lastly, dehumanised vaccination and the difficulties of access to healthcare were institutional determinants. Nurses ask for a vaccine promotion by hierarchy and doctors with transparent information and respect for autonomy. The availability of vaccines and methods of pain control seem to be some tracks to reduce nurses' VH.
ABSTRACT
CONTEXT: In France, breast cancer has been the most commonly diagnosed and the most lethal cancer in women. The risk-benefit ratio of organized breast cancer screening has been the focus of much scientific controversy, especially about overdiagnosis. A citizen conference and some scientific organizations have asked for a better education for women. The aim of this study was to analyze the numerous decision support tools and other information media, both in form and in substance. METHODS: A review of the existing publications has been done by 4 researchers between 2006 and 2016. Original articles included, in French or in English, focused on information media or decision aid tools for organized screening without any restriction on the type of studies. RESULTS: The 69 articles included in this review have shown that a better education of the patients was not related to an increase in the will to take part or in the actual participation in screening. The information media (pamphlet, video ) does not appear to have any influence on those ratios. The participants like having a discussion with a trained interviewer. In a third of the studies, the population was included on ethnic and social criteria. 8 studies focused on overdiagnosis. CONCLUSION: This review underlines the importance of repeated interviews, as a support for shared decision making. Specific interactions (such as patient navigator) could help to reduce social health inequalities. The patients should be informed about the current uncertainty regarding the ratio of overdiagnosis.
ABSTRACT
Scientific controversies on breast cancer screening have induced the French authorities to launch online citizen consultation. The objective of this netnography was to identify the knowledge and values underlying contributors' choices. The choice of supporters was often based on emotions: impression of disease severity and efficacy of screening, fearfulness stemming from personal experience and testimony from relatives. Opponents emphasized the risks of the screening and the doctors' perceived lack of relational and technical skills. The 'non-decision' profile was explained by information deemed simplistic, guilt-inducing and partial. Future research should focus on how to appeal to emotions to support shared decision.
Subject(s)
Breast Neoplasms , Breast Neoplasms/diagnosis , Decision Making , Early Detection of Cancer , Female , Humans , Mass Screening , Referral and ConsultationABSTRACT
CONTEXT: In France, breast cancer has been the most commonly diagnosed and the most lethal cancer in women. The risk-benefit ratio of organized breast cancer screening has been the focus of much scientific controversy, especially about overdiagnosis. A citizen conference and some scientific organizations have asked for a better education for women. The aim of this study was to analyze the numerous decision support tools and other information media, both in form and in substance. METHODS: A review of the existing publications has been done by 4 researchers between 2006 and 2016. Original articles included, in French or in English, focused on information media or decision aid tools for organized screening without any restriction on the type of studies. RESULTS: The 69 articles included in this review have shown that a better education of the patients was not related to an increase in the will to take part or in the actual participation in screening. The information media (pamphlet, video ) does not appear to have any influence on those ratios. The participants like having a discussion with a trained interviewer. In a third of the studies, the population was included on ethnic and social criteria. 8 studies focused on overdiagnosis. CONCLUSION: This review underlines the importance of repeated interviews, as a support for shared decision making. Specific interactions (such as patient navigator) could help to reduce social health inequalities. The patients should be informed about the current uncertainty regarding the ratio of overdiagnosis.
