From prospective clinical trial to reducing social inequalities in health: The DESSEIN trial, concept and design of a multidisciplinary study in precarious patients with breast cancer.
Anthropologist
Breast cancer
Epidemiologist
Geographic information system
Health economist
Health geographer
Precariousness
Qualitative interviews
Social inequalities in health
Socio-economic deprivation
Stage at diagnosis
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
04 Nov 2019
04 Nov 2019
Historique:
received:
31
07
2019
accepted:
10
09
2019
entrez:
6
11
2019
pubmed:
7
11
2019
medline:
30
1
2020
Statut:
epublish
Résumé
In France during the last 15 years, precariousness among women has increased. In breast cancer, precariousness has been associated with an increase in mortality, but the links between precariousness, stage at diagnosis and care pathway are little explored. Our study aims to evaluate the impact of precariousness on care pathways, treatment and recovery phase according to a multidisciplinary analysis. Comparative prospective observational multicenter study of exposed / unexposed category. Patients with breast cancer are recruited in the Ile de France area. Three scores are used to identify precarious patients. Precarious patients are matched to non-precarious patients by age group. Questionnaires are distributed to patients at different times of care. The main objective is to compare the stage of the disease at diagnosis between two groups. The secondary objectives are: comparison of socio-economic and geographical characteristics, direct and indirect costs, personal trajectories of care and health. Analysis include multidisciplinary approaches. A geographical information systems method will evaluate the accessibility to health facilities and the characteristics of the places of residence of the patients. An anthropological analysis will be conducted through observation of consultations and semi-directed interviews with patients. These methods will allow to analyze the diagnostic and therapeutic routes, placing it in a life history and an economic, socio-cultural and health environment. The economic analysis will include a comparison of direct, indirect costs and out-off pocket costs, from the patient's point of view and from the societal perspective. Conducted in a clinical setting and coupled with a qualitative study, this study will provide a better understanding of how contextual factors, combined with individual factors, can influence the course of health and thus the stage of the disease at diagnosis. The multidisciplinary approach, involving clinicians, geographers, an anthropologist, an economist and a health epidemiologist, will allow a multidimensional approach to the impact of precariousness on breast cancer. ClinicalTrials.gov Identifier: NCT02948478 registered October 28, 2016. 2016-A00589-42. protocol version: 2.1. decembre 13, 2018.
Sections du résumé
BACKGROUND
BACKGROUND
In France during the last 15 years, precariousness among women has increased. In breast cancer, precariousness has been associated with an increase in mortality, but the links between precariousness, stage at diagnosis and care pathway are little explored. Our study aims to evaluate the impact of precariousness on care pathways, treatment and recovery phase according to a multidisciplinary analysis.
METHODS AND DESIGN
METHODS
Comparative prospective observational multicenter study of exposed / unexposed category. Patients with breast cancer are recruited in the Ile de France area. Three scores are used to identify precarious patients. Precarious patients are matched to non-precarious patients by age group. Questionnaires are distributed to patients at different times of care. The main objective is to compare the stage of the disease at diagnosis between two groups. The secondary objectives are: comparison of socio-economic and geographical characteristics, direct and indirect costs, personal trajectories of care and health. Analysis include multidisciplinary approaches. A geographical information systems method will evaluate the accessibility to health facilities and the characteristics of the places of residence of the patients. An anthropological analysis will be conducted through observation of consultations and semi-directed interviews with patients. These methods will allow to analyze the diagnostic and therapeutic routes, placing it in a life history and an economic, socio-cultural and health environment. The economic analysis will include a comparison of direct, indirect costs and out-off pocket costs, from the patient's point of view and from the societal perspective.
DISCUSSION
CONCLUSIONS
Conducted in a clinical setting and coupled with a qualitative study, this study will provide a better understanding of how contextual factors, combined with individual factors, can influence the course of health and thus the stage of the disease at diagnosis. The multidisciplinary approach, involving clinicians, geographers, an anthropologist, an economist and a health epidemiologist, will allow a multidimensional approach to the impact of precariousness on breast cancer.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov Identifier: NCT02948478 registered October 28, 2016.
ID RCB
UNASSIGNED
2016-A00589-42. protocol version: 2.1. decembre 13, 2018.
Identifiants
pubmed: 31684919
doi: 10.1186/s12889-019-7611-6
pii: 10.1186/s12889-019-7611-6
pmc: PMC6829797
doi:
Banques de données
ClinicalTrials.gov
['NCT02948478']
Types de publication
Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1450Subventions
Organisme : INCA
ID : 2015-1-PL SHS-01
Références
Prev Med. 2012 Mar-Apr;54(3-4):259-65
pubmed: 22296836
BMC Public Health. 2013 Sep 10;13:823
pubmed: 24015917
J Natl Cancer Inst. 2007 Sep 19;99(18):1384-94
pubmed: 17848670
Med Care. 1996 Dec;34(12 Suppl):DS197-9
pubmed: 8969326
N Engl J Med. 2008 Jun 5;358(23):2468-81
pubmed: 18525043
Eur J Health Econ. 2007 Mar;8(1):5-15
pubmed: 17216424
Annu Rev Public Health. 2003;24:25-42
pubmed: 12668754
J Epidemiol Community Health. 2012 Nov;66(11):982-9
pubmed: 22544918
Presse Med. 2004 Jun 19;33(11):710-5
pubmed: 15257227
J Clin Oncol. 2013 Feb 10;31(5):536-42
pubmed: 23295802
BMJ. 2006 Dec 2;333(7579):1138
pubmed: 17138977
Value Health. 2012 May;15(3):429-36
pubmed: 22583452
Int J Cancer. 2006 Sep 1;119(5):1145-51
pubmed: 16557599
Br J Cancer. 2006 Jan 16;94(1):152-5
pubmed: 16404368
Cancer. 2012 Oct 15;118(20):5084-91
pubmed: 22415708