Essai clinique randomisé par grappes portant sur le dépistage des symptômes et l’aiguillage automatique vers les soins de soutien chez les patients atteints de cancer gastro-intestinal sous traitement

Philippa Helen Hawley, Narsis Afghari, Catherine Courteau

Abstract


Objet : Mesurer l’effet de la mise en œuvre du dépistage des symptômes et de voies d’aiguillage vers les soins de soutien et les soins palliatifs pour les patients récemment dirigés vers une clinique canadienne d’oncologie gastro-intestinale.

Méthodologie : On a recruté 88 sujets pour chaque groupe de traitement. Les sujets du groupe expérimental, lorsque l’intensité de leurs symptômes dépassait 3 sur 10 sur l’échelle d’évaluation des symptômes d’Edmonton (Edmonton Symptom Assessment System ou ESAS), ont été évalués par un membre de l’équipe des soins palliatifs et de soutien. Les sujets du groupe témoin ont reçu les soins usuels, et ont été dirigés vers d’autres services selon l’évaluation du professionnel de la santé. L’intensité des symptômes a été évaluée pendant les 5 mois qui ont suivi. On a aussi colligé les données sur la survie, le lieu du décès (domicile, maison de soins palliatifs, hôpital) et le séjour en établissement de soins de longue durée.

Résultats : Le dépistage a mené à 141 visites de spécialistes des soins palliatifs et de soutien dans le groupe expérimental contre seulement 9 dans le groupe témoin. On n’a cependant noté aucune autre différence significative dans l’intensité des symptômes ou l’évolution à long terme. Plusieurs patients dont l’intensité des symptômes dépassait 3 sur 10 ne voulaient pas consulter de spécialiste des soins palliatifs et de soutien ou n’en avaient pas besoin; en ce qui concerne les personnes ressentant de la détresse aiguë, soit elles avaient déjà été dépistées par l’équipe d’oncologie, soit elles étaient trop malades ou accablées pour participer à l’étude. Les spécialistes n’ont pas été débordés. L’étude a révélé l’importance de bien choisir le moment et le mode d’administration des outils de dépistage.

Conclusion : Le dépistage de routine des symptômes peut être lourd pour les patients; il doit donc rester le plus simple possible. Le triage des malades nécessitant un suivi (selon les résultats du dépistage) échoit aux infirmières en oncologie. Le fait de former les équipes d’oncologie à la prise en charge de cas simples de détresse permet d'utiliser de façon optimale les quelques rares spécialistes soins palliatifs et de soutien aux patients ayant des besoins complexes.


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References


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