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Le vécu du diagnostic et de la phase thérapeutique initiale par les personnes atteintes de pathologies cancéreuses : quels rôles pour la médecine générale au prisme des inégalités sociales de santé ?

Abstract : The general practitioner is the main actor in the organisation of primary care, as defined by the laws in force, both nationally and internationally. However, its role in the care of cancer patients remains both fluctuating, depending mainly on the social position of the patients, and difficult to identify, both in terms of time and context. A series of studies have been carried out to try to better understand the role of the general practitioner in the initial management of cancer, i.e. from the diagnostic period to the therapeutic phase itself. An initial qualitative study of 83 people with cancer (PWC) identified the main ways in which the health care system was used and what roles the general practitioner could play in these situations. A second qualitative component with health professionals, including general practitioners, clarified these roles, while a quantitative component was conducted to describe from cancer patient records the modalities of using a general practitioner. The trajectories of PWC were all the more marked by endurance logics as they were socially disadvantaged or from working class backgrounds. We also observed how the difficulties related to the patient's work were burdened by intersectionality logics. From a complete absence in the trajectories of some PWCs to a major role for others, the discovery of cancer and follow-up during the initial therapeutic phase, defining the role that the general practitioner can play requires an analysis of the entire spectrum of possible interventions, of which heterogeneity remains the rule. Nevertheless, during the two main phases, the peri-diagnostic phase and the initial therapeutic phase, the general practitioner is defined by the practice of interface medicine. This interface is temporal, making it possible to support the PWC in the biographical rupture particularly heavy with consequences in cancer pathology. But it is also spatial, being able to support the PWC in referring to the oncology care team, then when anti-cancer treatments are used, to the professionals in charge of this specificity. Like any interface, it is only visible to PWCs when it is crossed and remains in the shadows before and after, at home and in hospital. The issue then becomes that of communication, or how the general practitioner is able, through his knowledge, skills, posture and words, to forge sufficiently strong links to help the patient in his quest for recovery and in his work of physical, psychological and social reconstruction.
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  • HAL Id : tel-02491746, version 1

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Guillaume Coindard. Le vécu du diagnostic et de la phase thérapeutique initiale par les personnes atteintes de pathologies cancéreuses : quels rôles pour la médecine générale au prisme des inégalités sociales de santé ?. Sociologie. Université de Nanterre - Paris X, 2019. Français. ⟨NNT : 2019PA100050⟩. ⟨tel-02491746⟩

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