Consultation to Announce the End of Chemotherapy and Specific Treatments in an Outpatient Setting: Evaluation of the Psychological Impact and Information Exchange.
Condition: Cancer
Study type: Observational

Summary: 
      The average 5-year survival rate for patients diagnosed with cancer in France is estimated at
      53%. Nearly half of all patients diagnosed with cancer are not alive 5 years after diagnosis
      Discontinuation of anti-tumor treatments is therefore a major issue in their care. Discussing
      the discontinuation of specific treatments requires scientific oncological skills but also
      communication skills. The difficulties encountered by oncologists concerning communication
      about the end of life are linked to the doctors' personal discomfort with death, their fear
      of the responsibility of stopping chemotherapy, and their distrust of their colleagues. On
      the other hand, they may also come from patients who are supposedly reluctant to talk about
      the end of life, a reluctance that is heightened in the case of language barriers, young age
      or pressure from families. Finally, the place of practice could explain some of the
      difficulties in talking about the end of life, notably because of a lack of training in
      delivering bad news or a stigma attached to palliative care.

      This exploratory work should make it possible to describe the characteristics of the
      announcement of the cessation of anti-tumor treatments in ambulatory patients, to evaluate
      distress, anxiety, depressive symptomatology, as well as the satisfaction of the patients
      concerning the management received.
    

Detailed description: 
      In this pilot study, we will describe for the first time the discontinuation of anti-tumour
      treatments in outpatients with advanced cancer and evaluate the psychological impact on
      patients following this announcement.

      In outpatients patients, these announcements of treatment cessation will be made in a
      conventional oncology consultation or in Palliative Care Day Hospital.

      This exploratory work should make it possible to describe the characteristics of the
      announcement of the cessation of anti-tumour treatments in ambulatory patients, to assess
      distress, anxiety, and the depressive symptomatology, as well as patient satisfaction with
      the treatment received.

      The 2 hypotheses of this research work are the following:

        1. the announcement of the cessation of specific treatments can generate distress, anxiety
           and depressive symptoms for the patient, and may be a source of dissatisfaction with the
           quality of care received.

        2. the existence of an improvement in the quality of the announcement when it is made in
           HDJ SP in comparison with an announcement made in a conventional oncology consultation;
           reduction of the psychological impact for the patient, reduction in markers of
           aggressiveness of care at the end of end of life care. The doctors involved in this
           project have received training in listening to and supporting patients with advanced
           cancer in a palliative situation.
    

Intervention name(s): announcement of cessation of treatment
Intervention type(s): Behavioral
Intervention description(s): The first 40 outpatients for whom an announcement to stop anti-tumour treatments is made at the Institut Curie Paris, in a conventional oncology consultation or in Palliative Care Day Hospital.
Categorical variables will be described by numbers and percentages. Quantitative variables will be described by the mean, standard deviation, median of the distribution as well as the minimum, maximum and interquartile range and compared by a Student's t test or a Wilcoxon test according to the normality of the variables.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Chronological inclusion of the first 40 outpatients for whom an announcement to stop
        anti-tumour treatments was made at the Institut Curie Paris, in a conventional oncology
        consultation or in a Palliative Care Day Hospital
      
Keywords: Quality of end of life; Palliative care; Announcement of cessation of treatment