[Quality of life assessment as a gateway to the patient's individuality]. / Évaluation de la qualité de vie comme ouverture sur l'individualité du patient.

In the context of increasing life expectancy and complex medical situations, quality of life assessment can be a gateway to the patient's individuality and support medical decision making. There are different qualitative and quantitative assessment tools, ranging from a simple question that starts the discussion to standardized questionnaires. It is necessary to distinguish quality of life assessment in its economic, research and quality of care improvement perspective, from its evaluation within the doctor-patient relationship. Questionnaires such as Patient-Reported Outcome Measures (PROMs) could be interesting in daily clinical practice to improve communication and consultation efficiency, but their routine implementation still remains a challenge.

Dans le contexte de l'augmentation de l'espérance de vie et de situations médicales complexes, l'évaluation de la qualité de vie permet de s'ouvrir à l'individualité du patient et soutient la décision médicale. Il existe différents outils qualitatifs et quantitatifs pour l'évaluer allant d'une simple question qui ouvre le dialogue à des questionnaires standardisés. Il convient de dissocier l'évaluation de la qualité de vie dans sa perspective économique, de recherche et d'amélioration de la qualité des soins, de son évaluation au sein de la relation médecin-malade. Les questionnaires de type Patient-Reported Outcome Measures (PROMs) pourraient s'avérer intéressants dans la pratique quotidienne pour améliorer la communication et l'efficience d'une consultation, mais leur mode d'implémentation en routine reste un défi.

Describing adverse events in Swiss hospitalized oncology patients using the Global Trigger Tool.

BACKGROUND AND AIMS: The occurrence rate of adverse events (AEs) related to care among hospitalized oncology patients in Switzerland remains unknown. The primary objective of this study was to describe, for the first time, the occurrence rate, type, severity of harm, and preventability of AEs related to care, reported in health records of hospitalized hematological and solid-tumor cancer patients in three Swiss hospitals. METHODS: Using an adapted version of the validated Global Trigger Tool (GTT) from the Institute for Healthcare Improvement, we conducted a retrospective record review of patients discharged from oncology units over a 6-week period during 2018. Our convenience sample included all records from adult patients (≥18 years of age), diagnosed with cancer, and hospitalized (>24 hours). Per the GTT method, two trained nurses independently assessed patient records to identify AEs using triggers, and physicians from the included units analyzed the consensus of the two nurses. Together, they assessed the severity and preventability of each AE. RESULTS: From the sample of 224 reviewed records, we identified 661 triggers and 169 AEs in 94 of them (42%). Pain related to care was the most frequent AE (n = 29), followed by constipation (n = 17). AEs rates were 75.4 per 100 admissions and 106.6 per 1000 patient days. Most of the identified AEs (78%) caused temporary harm to the patient and required an intervention. Among AEs during hospitalization (n = 125), 76 (61%) were considered not preventable, 28 (22%) preventable, and 21 (17%) undetermined. CONCLUSION: About half of the hospitalized oncology patients suffered from at least one AE related to care during their hospitalization. Pain, constipation, and nosocomial infections were the most frequent AEs. It is, therefore, essential to identify AEs to guide future clinical practice initiatives to ensure patient safety.

[Admission or non admission of patients with cancer to the ICU]. / Admission ou non-admission du patient oncologique aux soins intensifs.

Determining if a critically ill patient with cancer will benefit from medical care in an intensive care unit can be a real challenge. Studies show that anticipating critical situations in oncology and collaboration between oncologists and intensivists diminish mortality and enhance resource use. This article covers some of the facts to consider in order to improve the management of these patients.

La question du projet thérapeutique et de l'admission ou non aux soins intensifs (SI) d'un patient souffrant d'un cancer et se trouvant en situation critique peut être complexe à appréhender. La décision d'un tel transfert est lourde de conséquences pour les patients et leurs familles, ainsi que pour son coût humain et économique. Il est donc primordial d'avoir une réflexion en amont sur le bien-fondé de chaque transfert. Une concertation régulière impliquant le médecin traitant/l'oncologue et le malade/sa famille tout au long de l'évolution de la maladie permet de clarifier les situations susceptibles de conduire à un transfert en SI.