Oeuvres de Pascal : pensées, lettres et opuscules divers

Collection : Collection Napoléon-Chaix

Family physician involvement in cancer care follow-up: the experience of a cohort of patients with lung cancer.

PURPOSE There has been little research describing the involvement of family physicians in the follow up of patients with cancer especially during the primary treatment phase We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician s involvement in their follow up at the different phases of cancer METHODS In 5 hospitals in the province of Quebec Canada patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months whether they had metastasis or not, for a maximum of 18 months to assess aspects of their family physician s involvement in cancer care RESULTS Of the 395 participating patients 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey except at the advanced phase where a majority attributed this role to their family physician At baseline only 16% of patients perceived a shared care pattern between their family physician and oncologists but this pro portion increased with cancer progression Most patients would have liked their family physician to be more involved in all aspects of cancer care CONCLUSIONS Although patients perceive that the oncology team is the main party responsible for the follow up of their lung cancer they also wish their family physicians to be involved Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow up

Le « milieu » homosexuel suisse durant la Seconde Guerre mondiale

Cette contribution s'intéresse à l'existence de lieux de sociabilité helvétiques entre hommes qualifiés comme étant homosexuels ou encore homoérotes selon le point de vue militant. Dans un pays resté neutre au cours de la Seconde Guerre mondiale et replié sur lui-même par « Défense nationale », fédéral depuis 1848 en unifiant trois cultures linguistiques, la capitale économique, Zürich, ressort sans conteste comme étant celle de l'homosexualité. Aussi cet article expose-t-il les conditions pénales expliquant l'existence dans cette ville de l'unique association homosexuelle qui va perdurer au-delà du conflit mondial. Il analyse aussi son mode de fonctionnement et revendicatif excluant progressivement les femmes de son sein. Toutefois, le monde associatif ne représente que la surface des événements, et cette étude s'attache à montrer les fortes différences existant selon les régions : la Zürich de la guerre ne s'est pas substituée au Berlin d'avant 1933, et les contrées latines, bien que profondément influencées par le code Napoléon, n'apparaissent pas comme des enclaves de liberté. Tolérance sociale relative et discrétion volontaire des intéressés, tels sont les mécanismes de cette histoire.

Patient, primary care physician and specialist expectations of primary care physician involvement in cancer care.

BACKGROUND: In Canada, many health authorities recommend that primary care physicians (PCP) stay involved throughout their patients' cancer journey to increase continuity of care. Few studies have focused on patient and physician expectations regarding PCP involvement in cancer care. OBJECTIVE: To compare lung cancer patient, PCP and specialist expectations regarding PCP involvement in coordination of care, emotional support, information transmission and symptom relief at the different phases of cancer. DESIGN: Canadian survey of lung cancer patients, PCPs and cancer specialists PARTICIPANTS: A total of 395 patients completed questionnaires on their expectations regarding their PCP participation in several aspects of care, at different phases of their cancer. Also, 45 specialists and 232 community-based PCP involved in these patients' care responded to a mail survey on the same aspects of cancer care. RESULTS: Most specialists did not expect participation of the PCP in coordination of care in the diagnosis and treatment phases (65% and 78% respectively), in contrast with patients (83% and 85%) and PCPs (80% and 59%) (p < 0.0001). At these same phases, the best agreement among the 3 groups was around PCP role in emotional support: 84% and more of all groups had this expectation. PCP participation in symptom relief was another shared expectation, but more unanimously at the treatment phase (p = 0.85). In the advanced phase, most specialists expect a major role of PCP in all aspects of care (from 81% to 97%). Patients and PCP agree with them mainly for emotional support and information transmission. CONCLUSION: Lung cancer patient, PCP and specialist expectations regarding PCP role differ with the phase of cancer and the specific aspect of cancer care. There is a need to reach a better agreement among them and to better define PCP role, in order to achieve more collaborative and integrated cancer care.