Papers by Marilène Filbet
Le Centre pour la Communication Scientifique Directe - HAL - ENS-LYON, Jun 1, 2013
International audienc
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BMJ Supportive & Palliative Care, 2020
BackgroundThe paucity of empirical research examining complementary medicine (CM) use in palliati... more BackgroundThe paucity of empirical research examining complementary medicine (CM) use in palliative care in France compared with other countries results in a gap in scientific knowledge. This study aims to describe the frequency and the cause of palliative care patients consulting with a CM clinician along with the conventional physicians.MethodsThis study is an observational cross-sectional survey conducted in three palliative care centres in Lyon, France, between July 2017 and May 2018: two tertiary hospitals and one palliative care unit in a private hospital. Inpatients and outpatients visiting the palliative care clinics with a primary diagnosis of cancer were invited to participate in the study. Using a 19-item paper-based survey instrument, we collected data on the participants’ personal characteristics, health service utilisation and attitudes towards CM.ResultsFrom the 138 participants meeting the inclusion criteria, 100 (72.4%) were included in the study. On average, they w...
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Dix ans apres la premiere enquete francaise etudiant la frequence, les caracteristiques et la pri... more Dix ans apres la premiere enquete francaise etudiant la frequence, les caracteristiques et la prise en charge des ADP en cancerologie (1), il devenait necessaire de faire le point sur l'evolution de la situation. C'est ce que propose l'etude ADEPI.
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La gestion des opioïdes chez les patients cancéreux douloureux est toujours un sujet d’actualité.... more La gestion des opioïdes chez les patients cancéreux douloureux est toujours un sujet d’actualité. La douleur est en effet un symptôme extrêmement fréquent chez les patients atteints de cancer, à tous les stades de la maladie, et en particulier dans les formes avancées. Elle peut survenir dans différents contextes : elle est associée à la tumeur cancéreuse et peut annoncer une récidive ou une progression de la maladie tumorale dans 85 à 92 % des cas ; elle est due aux traitements antitumoraux (chirurgie, radiothérapie, chimiothérapie) dans 20 % des cas ; elle est indépendante de la maladie et de ses traitements dans 2 à 10 % des cas (1). Chez un patient douloureux atteint d’un cancer, une évaluation précise de la douleur (intensité, localisation, type de douleur, traitements suivis, etc.) et une bonne compréhension des mécanismes sous-jacents sont indispensables pour une prise en charge thérapeutique adaptée. Dans un grand nombre de cas, les douleurs associées à un cancer nécessitent...
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BMJ Supportive & Palliative Care, 2019
ObjectivesEarly palliative care leads to meaningful improvements in physical and psychosocial sym... more ObjectivesEarly palliative care leads to meaningful improvements in physical and psychosocial symptoms, as well as quality of life, in patients with advanced cancer. Patients with haematological malignancies, despite a high level of distress, continue to have less access to palliative care services. The aim of this study was to identify haematologists’ perceptions of palliative care, as well as barriers to patient referral.MethodsWe used a qualitative grounded theory methodology. Twenty-four medical haematologists involved in clinical practice from two French centres in Lyon—the Lyon Sud University Hospital and the Léon Bérard Cancer Center—were included. The interview guide questions aimed to establish the clinical situations which triggered referral to palliative care and how participants perceived palliative care.ResultsData saturation was reached after 14 interviews. The data analysis highlighted four themes. The aim of palliative care was clearly identified as alleviating sever...
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Journal of Clinical Oncology, 2012
e19578 Background: Breakthrough pain in cancer (BTPc) can be assessed using a patient-reported 11... more e19578 Background: Breakthrough pain in cancer (BTPc) can be assessed using a patient-reported 11-pt pain intensity (PI) scale (0=no pain; 10=worst possible pain). Little information has been reported about variation of PI between episodes and between individuals. This analysis examined intra- and inter-patient variation in baseline PI scores among patients participating in BTPc clinical trials. Methods: This was a pooled analysis of data from 2 randomized, double-blind, crossover studies that treated BTPc with fentanyl pectin nasal spray (Lazanda®, PecFent®) compared with placebo or with morphine sulfate immediate release. Patients were adults with ECOG score ≤2 who experienced BTPc despite background pain that was adequately controlled with ≥60mg morphine (or equivalent). Each study included dose titration prior to the double-blind treatment phase of 10 episodes of BTPc. Inter- and intra-patient variability of baseline pain scores for each episode were analyzed by ANCOVA using a m...
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Journal of Clinical Oncology, 2016
6578Background: The frequency of passive decisional control (pt prefers physician to make decisio... more 6578Background: The frequency of passive decisional control (pt prefers physician to make decisions) has been reported to be variable but generally larger among pts living in developing countries. This study aimed to determine the frequency of passive DCP among patients with advanced cancer (ACP) in different cancer centers across the world. To identify the association of passive DCP with their socio-demographic and clinical characteristics. Methods: 1492 ACP referred to palliative care in 11 countries underwent assessment of decisional control preferences using a validated tools including Control Preference Scale tool, Satisfaction with Decision Scale and understanding of illness questionnaire. Information regarding patient characterstics including age, gender, education, marital status, employment, Karnofsky Performance Scale, cancer stage and type, religion were also collected. Descriptive statistics and Logistic regression analysis were performed. Results: Median age was 58 years, karnofsky 70, and 55...
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Bulletin du Cancer, 2018
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Journal of Clinical Oncology, 2016
212 Background: Methadone is used more and more as a second-line treatment for refractory cancer ... more 212 Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. Methods: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min). Results: Pain was nociceptive in 16% and mixed in 84%. 85% of the patients had breakthrough pain. Half received oxycodone, 1/5 fentanyl, 1/5 morphine and < 10% hydromorphone. Reasons for switching were lack of efficacy isolated (56%), or with intolerance to previous opioid (38%). More than 2/3 of the patients reached a pain score < 5 for two days at D4, adequate pa...
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The Journal of Community and Supportive Oncology, 2014
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Journal of Thrombosis and Haemostasis, 2017
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Bulletin du cancer, 2013
In cancer patients, decision-making process is crucial and patient's involvement is described... more In cancer patients, decision-making process is crucial and patient's involvement is described as a central component. In 2005, a new tool appears to convey patient's opinion even if he is not able to communicate anymore: advanced directives (AD). Unfortunately, their documentation is marginal. The objective of this study was to investigate nurses' and physicians' representations towards AD. A questionnaire had been sent to hospitals, public health facilities and liberal practitioners during February 2012. We collected responses from 42/251 physicians (17 %) and 80/198 nurses (40 %). Sixty percent of participants reported that they were not familiar with the legislative framework for AD. For physicians, main barriers were patient cognitive impairment (P = 0.004) and lack of information on the clinical situation (P = 0.004). For nurses, difficulties were toward end of life and prognosis discussion (P = 0.002), clinical situation evolution since AD documentation (P = 0....
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Médecine Palliative : Soins de Support - Accompagnement - Éthique, 2012
ABSTRACT Introduction Very often, specialized palliative care service access for patients who nee... more ABSTRACT Introduction Very often, specialized palliative care service access for patients who needed it is delayed. The early intervention in the course of illness could improve the quality of care and prevent the crisis events by improving symptom management and quality of life. Our hypothesis is that nurses have misconceptions about palliative care, considering referral only when the disease is at terminal stage. Methods First, our team conducted a study exploring physicians’ representation in 2008 and we replicate this study using the same questionnaire but for nurses in the same university hospital. Results One hundred and seventy-two questionnaires were sent and we received 107 answers (62%). One of two nurses thinks that the palliative care referral is not adapted in an early stage. They are afraid of generating patient anxiety. They felt difficult to determine the right time for a palliative care referral. Pain was the first symptom justifying a referral to the palliative care team, but they did not report any other symptom. The other reasons reported for referral to palliative care were support, comfort and accompaniment. The psychosocial distress or family distress were quoted less often. Conclusion Despite 5 years of training and information with nurses, palliative care understanding is still linked with the end of live care.
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Annales françaises d'anesthèsie et de rèanimation, 2014
Active treatment withholding and withdrawing decisions in the emergency room (ER) must be taken c... more Active treatment withholding and withdrawing decisions in the emergency room (ER) must be taken collegially according to ethical and juridical statements. Specific tools can support this process and our main goal was to create and validate such a tool. We created a first version of a tool to help for treatment withholding and withdrawing decisions inspired by similar documents from literature. Every item of this tool was then assessed by a group of experts (ER physicians and nurses) using the Delphi method to reach a consensus. Thirty-four experts from eleven ER (academic, regional centre) were included and participate to the first round and twenty-seven to the second round. From the eighty-two-item tool, sixty-five items reach a consensus during these two rounds and were kept to constitute the final version of the tool. We have been able to create a tool to help for treatment withholding and withdrawing decisions adapted to the guidelines for end of life patient's management in...
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BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF
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LYON1-BU Santé (693882101) / SudocSudocFranceF
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SALUTE E SOCIETÀ, 2017
Education and training in palliative care are a challenging issue needing to be addressed to meet... more Education and training in palliative care are a challenging issue needing to be addressed to meet the need of patients and families, across a range of clinical setting as home, hospital, nursing home. Since 1992 the EAPC has been aware of the importance of education for the development of palliative care and suggested some recommendations for health professionals in order for them to give the best palliative care. Three levels of education are required, from basic to specialist level, for skill, knowledge and attitudes. The training should provide competencies in the field of symptoms management but also in psychosocial suffering, decision making and legal aspects of palliative care, with attention to the patient and families beliefs and experience during the disease. This global approach needs to have the multi-disciplinary aspects and team working included in the training regardless of the student’s profession. This specific approaches benefit to the health care professional and give an ability to provide better care for all patients, in palliative situation or not.
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Papers by Marilène Filbet