A Brémond

Centre Léon Bérard, Lyons, Rhône-Alpes, France

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Publications (181)440.23 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: (1) To explore empirically the extent to which early stage breast cancer patients in France, wish to be informed about their disease and treatments and (2) in view of the statutory duty of physicians to inform patients, to explore, from the patients' point of view, the type of information given by physicians and whether it meets their information needs. A retrospective, cross-sectional survey questionnaire using standardized questions was administered by mail to newly diagnosed breast cancer patients and evaluated their relationships with the different physicians involved in their treatment at different points in time. Focus was placed on the relationship between surgeons and patients. Two hundred and thirty-eight patients completed the questionnaire on their relationship with their surgeon. Patients' reported information needs are considerable, though significantly different depending on the item. Patients report that surgeons do not fully respond to their needs. Even though physicians are legally required to provide information to their patients, in routine practice they seem to favour providing information about disease and treatment side effects over treatment consequences, even though patients express a need for information on these latter items. More research is needed on the development, use and outcomes of the various strategies and interventions designed to facilitate and improve information transfer in the physician-patient encounter in France.
    No preview · Article · Feb 2009 · Health Policy

  • No preview · Article · Jan 2009
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    ABSTRACT: In the shared decision-making model, both the physician/healthcare professional and the patient/healthcare consumer are seen as partners in the decision-making process. The concept appeared in France in the nineties, as part of the democratic healthcare system. Interestingly, the concept mobilises healthcare professionals, academic specialists, health decision-makers and obviously healthcare consumers/patients. In the present article we will first describe the evolution of the shared decision-making approach in France on the basis of legal and administrative documents. We will then present studies investigating the topic in cancer, which is our main research area.
    No preview · Article · Jan 2009 · Journal d'Economie Medicale
  • F. Nguyen · N. Moumjid · A. Brémond · M.-O. Carrère
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    ABSTRACT: Background/Purpose: Discrete Choice Experiments (DCE) consist in providing individuals with fictive scenarios in which characteristics of goods to be evaluated are varying, and asking them to indicate their preferences. Under some behavioural hypotheses, DCE allows to explain individuals' trade-offs between those characteristics. Since Hormone Replacement Therapy (HRT) presents risks, benefits and monetary costs we aim to explore the potentialities of DCE regarding individual preferences elicitation, by an application to HRT. In this paper, we study the theoretical validity of the method by testing standard hypotheses: internal consistency, transitivity, and stability of the preferences, no lexicographic preferences. Methods: Eleven pairs of scenarios were derived from the following HRT attributes: climacteric troubles, osteoporosis fractures, colorectal cancer, breast cancer, cardiac risk, thromboembolism risk, and monetary cost of the treatment. Women's demographics and medical background were also collected. Theoretical validity was tested by descriptive statistics. Results: 462 women aged 45 to 65 and from Lyon, France, sent back their questionnaires. Internal consistency, transitivity and stability of preferences were observed in large proportions of women (95%, 97% and 88%, respectively). Only 12% expressed dominant preferences. Conclusion: since theoretical hypotheses were verified, it will now be possible to estimate a utility function and to discuss women's preferences and willingness to pay for HRT.
    No preview · Article · Sep 2008 · Journal d'Economie Medicale
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    ABSTRACT: This paper deals with the physician-patient encounter. In France, the current legal framework allows patients to be informed (patients' rights to health information) and to participate to decisions regarding their own health. In such a context, this paper aims to give the reader the broad key components of the so-called 'patient treatment preferences elicitation process' in breast cancer, our research area. We first present the general context, with a definition of the different physician-patient models. We then present decision aids, tools that aim to provide high-quality information to patients in the decision-making process. Finally, based on our previous studies and on examples drawn from the international literature, we present the empirical process of patients' preferences elicitation, which not only increases patients' knowledge of and satisfaction with the decision made, but also allows patients to be part of their disease management. Far from being a phenomenon in the air supported by a legal system, this method developed in the 90s allows patients and more generally healthcare users to be autonomous without constraining them to a choice.
    No preview · Article · Jul 2008 · Revue d Épidémiologie et de Santé Publique
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    ABSTRACT: Background This paper deals with the physician-patient encounter. In France, the current legal framework allows patients to be informed (patients’ rights to health information) and to participate to decisions regarding their own health. In such a context, this paper aims to give the reader the broad key components of the so-called ‘patient treatment preferences elicitation process’ in breast cancer, our research area.
    No preview · Article · Jul 2008 · Revue d Épidémiologie et de Santé Publique
  • C Faure · J Escalon · A Brémond · H Mignotte · D Pérol · E Delay
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    ABSTRACT: Central breast cancer has long been an indication for mastectomy. Plastic surgical techniques adapted to cancer (oncoplastic surgery) have made it possible to offer breast cancer patients conservative surgery with resection of the nipple-areolar complex (NAC). We evaluated carcinologic results and cosmetic outcomes as a function of the oncoplastic technique used. We performed a retrospective study in 47 patients with central breast cancers undergoing breast-conserving with NAC resection. Carcinologic results were assessed by calculating local and metastatic recurrences rates. Cosmetic results were evaluated on four criteria assessed by the patient then by two surgeons. The mean age of the patients was 59.8 (44-84) years. The mean tumour diameter was 17.4 (6-39)mm. Histological involvement of the nipple is present in 53% of the cases. No local recurrence, neither death was observed at 4.5 years median follow-up. One patient had liver metastatic recurrence at 83 months. Cosmetic results were assessed in 33 patients. Round-block provided better aesthetic results: the shape of the breast was considered very good or satisfactory for 90% of the surgeons with the round-block technique and for 46% with transverse incision (P=0.02). Breast-conserving surgery is feasible in selected patients with T1 or T2 central breast cancers, with no impact on the risk of local recurrence. NAC resection is essential especially when the patients have clinical signs of nipple involvement. It provides satisfactory cosmetic results, especially with the round-block technique, possibly associated with nipple reconstruction using the "cat-design" technique developed by our team.
    No preview · Article · May 2008 · Annales de chirurgie plastique et esthetique
  • C. Faure · J. Escalon · A. Brémond · H. Mignotte · D. Pérol · E. Delay
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    ABSTRACT: Les tumeurs mammaires centrales sont longtemps restées des indications de mastectomie. La chirurgie oncoplastique a permis de proposer des traitements chirurgicaux conservateurs avec ablation de la plaque aréolomamelonnaire (PAM). Dans cette étude, nous rapportons les résultats carcinologiques obtenus, après chirurgie conservatrice avec ablation de la PAM, pour 47 patientes atteintes de tumeurs mammaires centrales. Les résultats esthétiques ont été évalués en fonction des deux techniques chirurgicales utilisées pour l’ablation de la PAM : une courte incision transversale ou une incision péri-aréolaire dite round-block. L’age moyen des patientes était de 59,8 ans, la taille histologique moyenne de 17,4 mm. Le mamelon était retrouvé histologiquement atteint dans 53 % des cas. Aucune récidive locale et aucun décès n’ont été rapportés, avec un suivi moyen de 4,5 ans. Une seule patiente a présenté une récidive métastatique. L’analyse cosmétique a été effectuée pour 33 patientes. La technique de round-block a permis d’obtenir des résultats plus satisfaisants sur le plan esthétique, pour les quatre critères évalués (forme, volume, symétrie, déformation). La chirurgie conservatrice apparaît appropriée pour des tumeurs mammaires centrales T1 et T2, sans conséquences directes sur le risque de récidive locale ou la survie. La résection de la PAM est indispensable, surtout s’il existe des signes cliniques d’atteinte du mamelon. Les résultats esthétiques sont satisfaisants, particulièrement avec la technique de round-block associée ou non à la reconstruction immédiate du mamelon par la technique dite du cat-design développée par notre équipe.
    No preview · Article · Apr 2008 · Annales de Chirurgie Plastique Esthétique
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    ABSTRACT: La Méthode des Choix Discrets (MCD) est utilisée pour analyser les choix des consommateurs. Sous certaines hypothèses de comportement, elle permet d’expliciter les arbitrages des individus entre les attributs d’un bien ou d’un service. Le Traitement Hormonal substitutif de la Ménopause (THM) est caractérisé par des risques et bénéfices de santé et par un coût monétaire. Nous explorons dans cette situation la capacité de la MCD à révéler les préférences individuelles, en commençant par étudier sa validité théorique. Les comportements sont-ils conformes aux hypothèses standard : cohérence interne, transitivité et stabilité des préférences, absence de préférences lexicographiques, absence d’effet de présentation ? Méthode: Onze paires de scénarios ont été construites à partir d’attributs du THM : troubles climatériques, fractures, cancer colorectal, cancer du sein, risque cardiaque, risque thromboembolique, coût. Les variables sociodémographiques et médicales des femmes ont été collectées. Deux versions du questionnaire ont été développées pour tester les effets de présentation des probabilités. La validité théorique a été testée à l’aide de statistiques descriptives. Résultats: 462 femmes de la Région Rhône-Alpes âgées de 45 à 65 ans ont renvoyé leur questionnaire. La cohérence interne, la transitivité, et la stabilité des préférences sont observées dans de larges proportions (95%, 97% et 88% des femmes respectivement.). Seules 12% des femmes expriment des préférences lexicographiques. Aucun effet de présentation sur la qualité des réponses n’est détecté. Conclusion: Compte tenu de la bonne conformité des comportements aux hypothèses, il sera possible d’estimer une fonction d’utilité et de discuter les préférences des femmes pour le THM ainsi que leur disposition à payer.
    Preview · Article · Dec 2007
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    ABSTRACT: This article aims to explore 1) whether after all the research done on shared decision making (SDM) in the medical encounter, a clear definition (or definitions) of SDM exists; 2) whether authors provide a definition of SDM when they use the term; 3) and whether authors are consistent, throughout a given paper, with respect to the research described and the definition they propose or cite. The authors searched different databases (Medline, HealthStar, Cinahl, Cancerlit, Sociological Abstracts, and Econlit) from 1997 to December 2004. The keywords used were informed decision making and shared decision making as these are the keywords more often encountered in the literature. The languages selected were English and French. The 76 reported papers show that 1) several authors clearly define what they mean by SDM or by another closely related phrase, such as informed shared decision making. 2) About a third of the papers reviewed (25/76) cite these authors although 8 of them do not use the term in a manner consistent with the definition cited. 3) Certain authors use the term SDM inconsistently with the definition they propose, and some use the terms informed decision making and SDM as if they were synonymous. 4) Twenty-one papers do not provide or cite any definition, or their use of the term (i.e., SDM) is not consistent with the definition they provide. Although several clear definitions of shared decision making have been proposed, they are cited by only about a third of the papers reviewed. In the other papers, authors refer to the term without specifying or citing a definition or use the term inconsistently with their definition. This is a problem because having a clear definition of the concept and following this definition are essential to guide and focus research. Authors should use the term consistently with the identified definition.
    Preview · Article · Sep 2007 · Medical Decision Making
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    ABSTRACT: To determine the optimal injection path for blue dye and radiocolloid for sentinel lymph node (SLN) biopsy in early breast cancer. A prospective randomized multicentric study was initiated to compare the peritumoral (PT) injection site to the periareolar (PA) site in 449 patients. The detection rate of axillary SLN by lymphoscintigraphy was significantly higher (P = .03) in the PA group (85.2%) than in the PT group (73.2%). Intraoperative detection rate by blue dye and/or gamma probe was similar (99.11%) in both groups. The rate of SLN detection was somewhat higher in the PA group than in the PT group: 95.6% versus 93.8% with blue dye (P = .24) and 98.2% versus 96.0% by probe (P = .16), respectively. The number of SLNs detected by lymphoscintigraphy and by probe was significantly higher in the PA group than in the PT group, 1.5 versus 1.2 (P = .001) and 1.9 versus 1.7 (P = .02). The blue and hot concordance was 95.6% in the PA group and 91.5% in the PT group (P = .08). The mean ex vivo count of the SLN was significantly higher in the PA group than in the PT group (P < .0001). This study strongly validates the PA injection technique given the high detection rate (99.1%) of SLN and the high concordance (95.6%) between blue dye and the radiotracer, as well as higher significant ex and in vivo counts, improving SLN probe detection.
    Preview · Article · Sep 2007 · Journal of Clinical Oncology
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    ABSTRACT: The debate concerning poorer survival for patients with breast cancer (BC) carrying a BRCA1 germline mutation is unresolved, and requires additional data from population-based studies. We followed 232 women with invasive BC under age 46, ascertained prospectively through a French population-based BC registry and tested for BRCA1/2 mutations (median follow-up: 82 months). We compared tumour characteristics and survival rates between 21 BRCA1/2 deleterious mutation carriers and 211 non-carriers. As compared to sporadic tumours, BRCA1/2 tumours showed higher grade (P = 0.02), fewer ductal carcinoma in situ (P = 0.02), more frequent medullary histology (P = 0.02), more frequent negative oestrogen and progesterone receptors (P = 0.001 each). At 5 years, BC-specific survival, metastasis-free survival, ipsilateral recurrence-free survival and contralateral BC-free survival rates for BRCA1/2 mutation carriers were 95.0%, 94.7%, 100% and 90.0% respectively, compared with 89.6%, 78.2%, 88.8% and 94.4% respectively, for non-carriers (not significant). Rates for women carrying only a BRCA1 mutation were 93.3%, 93.3%, 100%, 86.7%, respectively. 76% of BRCA1/2 carriers received chemotherapy. Despite unfavourable tumour features, we found no evidence for poorer short-term survival in BRCA1 mutation carriers compared to non-carriers in this prospective population-based cohort. The high rate of BRCA1 carriers who received chemotherapy for their BC should question the positive impact of this treatment, as suggested by preclinical studies showing increased chemosensitivity of BRCA1-associated tumours.
    No preview · Article · Feb 2007 · Breast Cancer Research and Treatment
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    ABSTRACT: In France, patients' claim for information and participation to medical decision-making was initiated in the eighties by AIDS associations, then reinforced by the tainted blood scandal and more recently by demands from cancer patients. The right to patient information was recognised on March 4th 2002 by the law pertaining to patients' rights and the quality of the healthcare system. The present article will explore this background by examining the bases, the current status and the development of shared decision-making in the physician-patient encounter in France. We will describe the evolution of the physician-patient relationship on the basis of legal and administrative documents, then show that patients' information, and more generally healthcare users' information, is a central concern for some national health institutions. Finally, we will demonstrate that even if the literature on shared decision-making is little developed in France as compared to other European countries, Northern America and Australia, some studies have nonetheless been conducted. Their results, combined with a legal context and national health institutions encouraging shared decision-making, should prompt otherwise reluctant healthcare professionals to implement this approach in everyday medical practice.
    No preview · Article · Feb 2007 · Zeitschrift fü Arztliche Fortbildung und Qualitatssicherung
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    ABSTRACT: Patients often search for a second opinion (i.e., a search for additional information on the diagnosis and/or treatment options and the potential prognosis, which will help the patient decide what to do or not to do, where, with whom and how). The scope of this phenomenon is not well documented. Also it is not clear if this is warranted or not. This paper aims to explore whether knowing that his clinician follows practice guidelines eliminates the need of a patient's to seek a second opinion. Given that practice guidelines should allow each patient to benefit from the best current clinical evidence, one might wonder if in such a context a second opinion is still necessary, and if so, for what reasons? We review the literature to find the reasons that may prompt a patient to seek a second opinion before the implementation of practice guidelines. We then analyse, from a conceptual point of view, whether for 'informed patient' (i.e., one who knows about and understands practice guidelines) these reasons still hold after the implementation of practice guidelines and if new reasons for seeking a second opinion have emerged. We also discuss practical limitations to searching for a second opinion. We show that even if some reasons, like the search for a second opinion to check whether the treatment prescribed by the first physician is appropriate or not, can be questioned after the implementation of practice guidelines, an 'informed patient' may still wish to seek a second opinion stemming from new reasons which have emerged after the introduction of practice guidelines, e.g., to determine which practice guidelines his physician follows and whether they are appropriate to his case. We conclude that the implementation of practice guidelines will not eliminate the need for a second opinion consultation. On the contrary, the use of guidelines can even stimulate a broader request for second opinions. This conclusion however needs to be validated in an empirical study.
    No preview · Article · Feb 2007 · Health Policy

  • No preview · Article · Jan 2007
  • [Show abstract] [Hide abstract]
    ABSTRACT: Discrete Choice Experiments (DCE) consists in providing individuals with fictive scenarios in which characteristics of the good to be evaluated are varying, and asking them to indicate their preferences. Under some behavioural hypotheses, DCE allows to explain individuals’ trade-offs between those characteristics. Since Hormone Replacement Therapy (HRT) presents risks, benefits and monetary costs we aim at exploring the potentialities of DCE regarding individual preferences elicitation, by an application to HRT. In this paper, we study the theoretical validity of the method by testing standard behavioural hypotheses: internal consistency, transitivity, and stability of the preferences, no lexicographic preferences, no framing effects. Methods: Eleven pairs of scenarios were derived from the following HRT attributes: climacteric troubles, osteoporosis fractures, colorectal cancer, breast cancer, cardiac risk, thromboembolism risk, and monetary cost of the treatment. Women’s demographics and medical background were also collected. Two versions of the questionnaire were developed and randomly administered allowing to test framing effects due to the presentation of probabilities. Theoretical validity was tested by descriptive statistics. Results: 462 women aged 45 to 65 and from Lyon, France, sent back their questionnaires. Internal consistency, transitivity and stability of preferences were observed in large proportions of women (95%, 97% and 88%, respectively). Only 12% expressed lexicographic preferences. No framing effect was detected on data quality. Conclusion: since behavioural hypotheses were verified, it will now be possible to estimate a utility function and to discuss women’s preferences and willingness to pay for HRT.
    No preview · Article · Jan 2007

  • No preview · Article · Jan 2007

  • No preview · Article · Jan 2007
  • Marie-Odile Carrère · Nora Moumjid · Alain Brémond

    No preview · Article · Dec 2006
  • A. Brémond · N. Moumjid · M.-O. Carrère
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    ABSTRACT: The analysis of consumers' preferences is a major theme of positive economics, just as respect for these preferences is the basis of normative economics or welfare economics. In the field of health care the consumers are the patients and it is the patients' preferences that are becoming a major research topic. Taking into account (or not) the patients' preferences in the context of a therapeutic decision can be referenced in a number of models defined mostly in the Anglo-Saxon literature, which in French refer to a "decision-maker doctor", a "decision-maker patient" and a "shared decision". Several experiments carried out at the Léon Bérard Centre in Lyon by a multidisciplinary team have led some doctors in this Centre to favour the practice of shared decision, as routine, for the management of breast cancer. But the satisfaction of the consumers' preferences, the patients' in this case, may come up against the availability of the health sector's resources, which result from social security payments to which the population has consented. This is a major issue which has still to be documented.
    No preview · Article · Sep 2006 · Journal d'Economie Medicale

Publication Stats

3k Citations
440.23 Total Impact Points

Institutions

  • 1996-2009
    • Centre Léon Bérard
      Lyons, Rhône-Alpes, France
    • University of Toronto
      Toronto, Ontario, Canada
  • 2007
    • Université Lumiere Lyon 2
      Брон, Rhône-Alpes, France
  • 2002-2007
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
    • University of Melbourne
      Melbourne, Victoria, Australia
    • The Society of Rheology
      Columbia, South Carolina, United States
  • 2005
    • Institut Claudius Regaud
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2001
    • Institut Bergonié
      Burdeos, Aquitaine, France
  • 1984-2001
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
  • 1998-1999
    • Institut Paoli Calmettes
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 1991-1994
    • Institut de Cancérologie Gustave Roussy
      • Department of Radiotherapy
      Île-de-France, France
  • 1975-1991
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France