HDR defense of Marion DOUPLAT on January 15, 2024

HDR defense of Marion DOUPLAT on January 15, 2024

Title: Evaluating the prognostic impact of Family-Patient-Caregiver interactions during urgent care visits 

Date : January 15, 2024 at 2:00 p.m.

Location : Salle des Thèses Rockefeller 8 avenue Rockefeller, 69373, Lyon cedex 08.

Jury :

Mme CHARPENTIER Sandrine, Professeure des Universités Praticien Hospitalier, Université de Toulouse ;
M. LE COZ Pierre, Professeur des Universités, AixMarseille Université ;
Mme MAZZA Stéphanie, Professeure des Universités, Université Lyon 1 ;
Mme POMEY MariePascale, Professeure, Université de Montréal (Canada) ;
Mme SCHOTT Annemarie, Professeure des Universités Praticien Hospitalier, Université Lyon 1 ;
M. TAZAROURTE Karim, Professeur des Universités Praticien Hospitalier, Université    Lyon 1 ;

Abstract :

My work is therefore in the field of emergency medicine, with the aim of assessing the prognostic impact of Family-Patient-Caregiver interactions during recourse to emergency care.

My research work began in Pr Pierre Le Coz's team at UMR n°7268 Anthropologie, droit, éthique et santé, CNRS-EFS at the University of Aix-Marseille, where I completed my PhD in Human Pathology-Ethics. This initial research work enabled me to explore the ethical issues involved in decisions to limit and stop treatment in emergency departments, which have been the subject of several international publications.

Later in my career, I continued my work as part of my affiliation with the RESHAPE research team (RESeArch on Healthcare Performance, U1290 Inserm - UCBL) at Lyon 1 University, directed by Pr Schott. RESHAPE's research activities focus on healthcare professionals, improving their performance and the quality of their care by acting on individual and organizational determinants and their relationship with the patient.

My research work is therefore integrated into RESHAPE's research activities, and is a continuation of my work in ethics.

I have developed my research around three axes in the emergency department:
- Family
- Patient axis
- Caregiver axis

In each of these three areas of research, we find patient partnership, simulation and medical ethics.

- Family axis: analysis of families' experience of complex announcements and patient partnerships.
Continuing the work of my science thesis on decisions to limit and stop therapies with the DOFAMILA project, I have obtained DGOS funding in 2019 as part of a research program on the performance of the healthcare system (PREPS) (470 K€) and co-funding from the Fondation de France (50 K€). The aim of this prospective multi-center interventional study is to assess the impact of a protocol for announcing decisions to limit and stop treatment, using human simulation and the involvement of partner families as training aids, on family stress. It will assess the impact on patients' families in terms of symptoms of anxiety, depression and the onset of post-traumatic stress disorder in complex announcement situations.

The originality of this project lies in the construction of the training program, which will include :
- a pedagogical aspect, using human simulation as a training medium.
- the involvement of partner families in the training of caregivers, in the form of training co-construction workshops. The partnership was developed in international collaboration with the University of Montreal (Canada) and in connection with the HCL partnership project (Projet PEPS). We used a mixed methodology, collecting quantitative evaluation data and qualitative data in the form of semi-structured interviews, the results of which are currently being published.
This theme has enabled us to develop patient partnership in the context of the emergency department, and links up with a study in which we evaluated the involvement of patient partners in France in terms of care, teaching and research, and interviewed patient partners in the form of semi-structured interviews about their involvement in an organizational project in the emergency department. These results have been published. The study of health literacy is another avenue for research into improving communication with patients.

- Patient axis: analysis of the patient pathway admitted to the emergency department and its prognostic determinants.
This axis has been developed thanks to several multi-center cohorts that have been financed on the themes of sepsis, cranial trauma and type 2 infarction, among others. In the context of the pandemic, we have set up funded cohorts of almost 25,000 emergency patients to assess the impact of COVID-19 in emergency departments on patient outcomes. The management of violence in emergency departments is another theme we have been working on, at the interface between the patient and caregiver axis. The MEDIA study examined the role of the mediator in the emergency department and the impact on caregivers. Other projects will be developed with the intervention of the patient partnership.

- Caregiver axis with the optimization of work quality factors in the emergency department and the study of caregiver performance.

The aim of this project is to identify work-related stress factors in the context of emergency medicine. Following initial studies published on the stress of emergency professionals (COVER PRO, and COVER PRO LT studies), we set up the REST project as part of a collaboration between RESHAPE INSERM U1290 and the University of Lyon 1 with Prof. Stéphanie Mazza, and the award of a doctoral grant for 3 years (2020-2024) to doctoral student Laura Schmidt. The aim of this project, which consists of a randomized interventional study, is to measure the impact of a recovery management program on the level of physiological stress during the management of acute events in the emergency department, using connected equipment (watch and vest measuring physiological parameters) in a population of caregivers. The next step will be to demonstrate the benefit of an intervention on the patient by reducing adverse events (DGOS call for projects underway). Other work in clinical ethics has been carried out as part of the supervision of Master 2 students, assessing the ethical dilemmas faced by carers in pre-hospital and intensive care during COVID. Finally, the development of leadership skills coupled with the management of professionals' well-being is also an area of research, and has been the subject of a study on interns.

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