Assessment of the Reasons for Accepting or Refusing Early Palliative Care

Overview

This is a prospective, multicentre study, considered as " non-RIPH ("Recherche n'Impliquant pas la Personne Humaine - Research that does not involve humans ". Indeed, the patient's participation in the study and the completion of the various questionnaires has no impact on patient's safety and is not likely to change patients' management. Patients accepting to take part to an early phase trial will be proposed to participate in the PALPHA-1 trial. They can accept or refuse to have palliative supportive care. The main objective of this study is to assess the reasons for accepting and refusing early palliative care in patients included in an early phase clinical trial. The secondary objectives will enable to describe and analyze the number (effective) and the rate (%) of acceptance and/or refusal of early palliative support, to assess patients' understanding and perception of the " combined " management by comparing the semantic content of the patient-investigator ecological interaction during the proposal for inclusion in the trial (i.e. what was explicitly said), with that of the semi-structured post-consultation inclusion interviews ( ie what the patients understood, perceived), to compare the quality of life and the anxiety-depression of patients according to their acceptance or refusal of the mixed care at the inclusion and at the end of the early phase trial, to compare the clinical, medical and socio-demographic characteristics of the patients, the overall survival of patients according to their acceptance or refusal of the combined management and finally for the patients accepting the Palliative Care Management (PCM), to describe throughout the study, the patients' compliance to palliative supportive care undertaken.

In a context of promotion of precision medicine, if palliative management and inclusion in an Early Clinical trial Phase (ECP) may at first glance appear antagonistic, some authors support the idea of a possible synergy in order to improve quality of life, reduce symptoms of exhaustion linked to treatment side effects and allow patients to complete their treatment protocol. To date and to our knowledge, few studies have assessed the brakes and/or levers for patient acceptance and/or refusal as well as the feasibility of a such mixed therapeutic management therapeutic. In this context, the beliefs and representations of patients must be taken into account in the decision-making process, which is also governed by the social norms of the caregiver-patient relationship. A better understanding of patients' acceptance and/or refusal of palliative care is an essential and innovative prerequisite for better understanding the processes involved at this stage of the care process. The main objective of this study is to assess the reasons for accepting and refusing early palliative care in patients included in an early phase clinical trial. The secondary objectives will enable to describe and analyze the number (effective) and the rate (%) of acceptance and/or refusal of early palliative support, to assess patients' understanding and perception of the " mixed " management by comparing the semantic content of the patient-investigator ecological interaction during the proposal for inclusion in the trial (i.e. what was explicitly said), with that of the semi-structured post-consultation inclusion interviews ( ie what the patients understood, perceived), to compare the quality of life and the anxiety-depression of patients according to their acceptance or refusal of the mixed care at the inclusion and at the end of the early phase trial, to compare the clinical, medical and socio-demographic characteristics of the patients, the overall survival of patients according to their acceptance or refusal of the combined management and finally for the patients accepting the PCM, to describe throughout the study, the patients' compliance to palliative supportive care undertaken. All patients approached for inclusion in an early phase clinical trial during the Multidisciplinary Consultation Meeting (MCR) will be offered to participate to the study. In order to assess the reasons for accepting / refusing the inclusion in palliative supportive care in patients entering an early phase clinical trial, two subgroups will be formed. The first group will be made up of patients who accepts joint palliative care (n = 20) and the second group of those who refuse (n = 20). Following their acceptance, the consultation for setting up the early phase clinical trial will be recorded and participants will be invited to participate in a semi-structured interview just before the first line of treatment. Patients (both having accepted or refused the palliative care) will also have to answer a self-questionnaire on quality of life and anxiety-depression at inclusion and at the end of the clinical trial. The study results will make it possible to determine patients' motivations for accepting or refusing palliative care management in order to better define their expectations, beliefs in terms of management, their understanding and impact of this management.