French Health professionals’ attitudes about patient empowerment in the cancer care pathway

Abstract

Objective: France is experiencing a shift in health policy. The purpose of this article is to describe how cancer care health professionals define patient empowerment, describe modalities of care of the cancer patient treated by intravenous means and identify avenues for reflection on the specific challenges facing patient-centered care, from the perspective of changes in practices in the cancer care pathway.Methods: 19 individual, semi-structured interviews with health professionals working in cancer care facilities were analyzed in a qualitative study, using the Theoretical Domain Framework linked to the COM-B model.Results: The organization of care is governed by three factors. First of all, the cancer care system focuses on the strictly curative aspect of this disease. All devices lead to management centered on the pathology, and not on the patient as a whole. Secondly, the fact that the patient suffers from cancer modifies the attitudes and representations of caregivers towards the patient. Cancer introduces a relational bias in each of the stakeholders. Thirdly, the current organization of nursing care maintains paternalistic and prescriptive care in the cancer care pathway. Only new nursing jobs (coordinating nurses or pivot nurses) suggest the possibility of switching to patient-centered care. The analysis from TDF linked to the COM-B model shows that the strategy of implementing a new tool to measure the level of patient engagement, in routine nursing care, must focus on the reflective opportunity and motivation of the stakeholders.Conclusions: Caregivers should be acculturated to patient empowerment. TDF linked to the COM-B model can make it possible to think about how to prepare and adapt this change in practice at several sites of cancer treatment. Training adapted to the context to familiarize current caregivers with this new form of care is currently being implemented. To succeed, acculturating current health care providers to this new form of care, while offering them a tool to objectively assess the level of patient empowerment would undoubtedly foster their involvement in supporting patient empowerment, while allowing them to evaluate the time required to integrate this type of care.

<p>Conditions for the Implementation of a Patient Education Program Dedicated to Cancer Patients Treated by Oral Anticancer Therapy</p>

“…A previous study by Verot et al corroborates these findings, showing that cancer caregivers find it difficult to change their care practices and strategies in support of the empowerment of cancer patients. 29 The patient, in hospital culture, is passive and abandons him/herself (consciously or not) to the care of hospital caregivers. This was explained in a report on a coordinated research program focused on PE between 2012 and 2015, in several French hospitals.…”

Researching Ageing

“…Patient participation has increased in recent years throughout Europe, particularly for younger people and those suffering from chronic conditions; however, the term is still commonly understood as following treatment recommendations within a more traditional paternalistic patient-provider relationship, shared decision-making is perceived by many as timeconsuming and a potential source of conflict, patient-provider communication skills are limited, and many HCPs and patients find it difficult to share responsibilities for healthrelated goals and choices (Commission européenne, 2012). In France, the current organization of nursing care tends to maintain a paternalistic and prescriptive way of care regarding patients suffering from chronic diseases (Verot et al, 2019).…”

“…To insure a good fit with the current routine care processes, we conducted a preliminary study to understand the social representations of HCPs involved in cancer care toward patient empowerment and the possible use of this tool. (Verot et al, 2019) Thus, a qualitative study was carried out in three cancer treatment centers representative of the cancer treatment offer in the territory.…”