Social inequalities in the face of cancer are significant in all countries. They are characterized by higher mortality among people may be in the lower socioeconomic category. The care pathway may also be a source of inequality or accentuate inequalities. Socially vulnerable patients must be provided with appropriate care. It is therefore necessary to identify patients with such social vulnerabilities as early as possible and to take them into account throughout the care process. To meet this need, the DEFCO project ("Detection of social frailties and coordination of the path of patients in cancer: a new approach by an expert computer system") was designed and conducted by the Centre Hygée at the Lucien Neuwirth Cancer Institute (ICLN) in 2014 and 2015, in partnership with an industrial engineering research laboratory, the DISP ("Décision \& Information pour les Systèmes de Production"). Its objective was to develop a tool for systematic screening of social fragility, involving few caregivers and making it possible to identify patients most at risk of social maladjustment. The choice was made to develop a self-administered questionnaire using tablets connected to a neural network. Since its implementation, the deployment of the DEFCO project ("Detection of social frailties and coordination of the path of patients in cancer: a new approach by an expert computer system") tool at the Lucien Neuwirth Cancer Institute (ICLN) has required several training and awareness-raising activities to strengthen the motivation of the various stakeholders. These same actors have also implemented different strategies to optimize the functioning of the tool. Developed in a specialized institution, this tool must demonstrate, in this second stage of the project, it transferability and it possibilities of implementation in other structures. It is also necessary to evaluate it in terms of it is impact, particularly on the fluidity of care pathways and on the social consequences of the disease.
The aim of this study is to evaluate the implementation of the DEFCO ("Detection of social frailties and coordination of the path of patients in cancer: a new approach by an expert computer system") social fragility tracking tool over one year.
Study Type
OBSERVATIONAL
Enrollment
437
The Detection of social frailties and coordination of the path of patients in cancer: a new approach by an expert computer system DEFCO tool is questionnaire to identify their social vulnerabilities. A neural network instantly identifies the patient's fragility and sends the result by email to the professionals identified in the organization of each center. These professionals then relay to the social workers in order to take care of the patient's fragility.
Centre Jean Perrin
Clermont-Ferrand, France
CH Emile Roux
Le Puy-en-Velay, France
Hospices Civils de Lyon - Lyon Sud
Lyon, France
Hospices Civils de Lyon, Centre Hospitalier Lyon Sud - Oncologie digestive
Lyon, France
Hospices Civils de Lyon, Groupement Hospitalier Est - Gynécologie
Lyon, France
Hospices Civils de Lyon, Groupement Hospitalier Nord - Gynécologie
Lyon, France
Chu Saint-Etienne
Saint-Etienne, France
Hôpital Privé de la Loire
Saint-Etienne, France
Population reach
Measured by number of actors who have been used DEFCO tool.
Time frame: Months: 12
Population reach
Measured by percentage of patient population included in relation to the target population.
Time frame: Months: 12
Population reach
Measured by rate of participation: number of patients included by physicians, proportion of patient who completed the tool, proportion of patients detected as socially fragile.
Time frame: Months: 12
Tool adaptation by professionals
Measured by number of tool variation according to centers.
Time frame: Months: 12
Change from 6 months PACIC questionnaire result at 12 months
Measured by comparison Patient Assessment of Chronic Illness Care Questionnaire (PACIC) by patient at 6 and 12 months after the inclusion. Patient Assessment of Chronic Illness Care Questionnaire (PACIC) is a questionnaire which evaluates care during chronic illnesses with minimum score at 0 (bad care assessment) and maximum score at 130 (good care assessment).
Time frame: Months: 6, 12
Evaluation of effectiveness in real life by PPE
Measured by comparison of Picker Patient Experience Questionnaire (PPE) between patients at 12 months after the inclusion. Picker Patient Experience Questionnaire (PPE) is a questionnaire which measures the patient experience with minimum score at 0 (no problem with health care access) and maximum score at 100 (problem with health care access).
Time frame: Months: 12
Change from baseline FACT-G questionnaire result at 12 months
Measured by comparison Functional Assessment of Cancer Therapy-General Questionnaire (FACT-G) by patient at the baseline and 12 months after. Functional Assessment of Cancer Therapy-General Questionnaire (FACT-G) is a questionnaire which measures the quality of life of the patient with minimum score at 0 (low quality of life) and maximum score at 108 (high quality of life).
Time frame: Months: 0, 12
Change from baseline HAD questionnaire result at 12 months
Measured evolution of Hospital Anxiety and Depression Questionnaire (HAD) at the baseline and 12 months after. Hospital Anxiety and Depression Questionnaire (HAD) is a questionnaire which measures evolution of patient anxiety by 2 sub-scores : * Anxiety sub-score: with minimum score at 0 (no anxiety) and maximum score at 21 (anxiety) * Depression sub-score: with minimum score at 0 (no depression) and maximum score at 21 (depression)
Time frame: Months: 0, 12
Evaluation of practices effectiveness by using the tool
Measured by proportion of patients who used the tool compared to patients who were included.
Time frame: Months: 12
Evaluation of effectiveness of practices by Personalized Care Project
Measured by number of social components integrated into the Personalized Care Project.
Time frame: Months: 24
Evaluation of effectiveness of practices by identification of support systems
Measured of number of support systems in each center.
Time frame: Months: 24
Evaluation of effectiveness of practices by patient's satisfaction: questionnaire
Measured by satisfaction questionnaire to the patient. Satisfaction questionnaire to the patient had 6 questions with minimum score at 0 (no contented) and maximum score at 18 (contented).
Time frame: Months: 12
Evaluation of effectiveness of practices by caregiver's satisfaction offering the tool: questionnaire
Measured by satisfaction questionnaire to the caregiver. Satisfaction questionnaire to the caregiver had 7 questions with minimum score at 0 (no contented) and maximum score at 21 (contented).
Time frame: Months: 24
Maintenance and institutionalization
Number of professionals made available for DEFCO tool.
Time frame: Months: 24
Change from baseline interview with professional at 12 months
Assessed by interviews with professionals who have used DEFCO tool. Interviews with professionals will be realized at the baseline and the end at the study.
Time frame: Months: 0, 24
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