La réduction des inégalités d'accès aux soins a toujours été un axe majeur des politiques de lutte contre le cancer. Alors qu'il existe de nombreuses études en cancérologie solide, peu d'études avec une méthodologie correcte existent en onco-hématologie, notamment chez les patients atteints de Myélome Multiple (MM). Cette maladie a vu son pronostic transformé par l'arrivée de nouvelles thérapeutiques dont l'usage a été rapidement intégré dans les recommandations de la Société Française d'Hématologie. L'objectif de travail intitulé Parcours de Soins des patients atteints d'hémopathie maligne en Poitou Charentes était donc de décrire et d'analyser les écarts aux recommandations, en prenant le MM comme premier exemple. Grâce au registre des Cancers Poitou-Charentes et à l'exhaustivité des cas qu'il assure, notre travail a permis de déterminer des variables associées à une inégalité d'accès aux soins. Ces variables sont démographiques (âge, distance entre le domicile et l'hôpital), liées à la tumeur (maladie symptomatique ou non), mais aussi organisationnelles (niveau de l'hôpital, passage en réunion de concertation pluridisciplinaire). De plus nous avons pu montrer que ces inégalités avaient un impact sur la survie globale des patients, notamment chez les plus âgés. Notre travail se poursuit par une analyse plus fine de la survie globale et l'étude des longs survivants du Myélome Multiple. A plus long terme, nous souhaitons appliquer cette approche à d'autres hémopathies. / French national Cancer plans aimed to reduce health care inequalities. These inequalities are well known in solid cancers but few data with correct methodology exist in Hematology, especially in Multiple Myeloma (MM). The new treatments in this disease have dramatically improved Overall Survival. So guidelines of the Société Française d'Hématologie have quickly recommended the use of these new drugs. The aim of our work: Care Pathway of patients with hematological malignancies in Poitou Charentes area was to describe and analyze non compliance to guidelines. Based on the exhaustivity of the Poitou Charentes Cancer Registry, our work revealed variables associated with healthcare inequalities. They were demographical (age, distance between home and hospital), tumor-related (symptomatic MM or not) but also organizational (level of the hospital, multidisciplinary meeting). Moreover we showed that those inequalities had a negative impact on overall survival, especially in elderly people. Our work continues with more accurate analysis of overall survival and a study on MM long survivors. Longer-term studies would be to transfer this approach to other hemopathies.

Despite the existence of effective treatments, mental health care disparities exist in the availability, accessibility, and quality of services for racial and ethnic minority groups. People living with serious mental complaints often resist engaging in treatments and experience high rates of dropout; poor engagement can lead to worse clinical outcomes. Addressing the complex mental health care needs of racial and ethnic minorities warrants considering evidence-based strategies to help reduce disparities. This systematic review sought to provide an analysis of published literature about the barriers and effective strategies in identifying and treating minority patients with mental health disorders. The practice-focused question of this systematic review was: What are the barriers and effective strategies to identification and treatment of mental health disorders among minority populations. This project was guided by PRISMA and SQUIRE guidelines and Fineout-Overholt and Melnyk’s appraisal form, comprising 11 studies published between 2014 and 2019, identified through Thoreau, Cochrane, CINAHL with Medline, EBSCO, and ProQuest, SAMHSA and PubMed databases. The systematic review results recommend intervention strategies such as integrated/collaborative care, workforce diversity, providers in minority neighborhoods, improving providers’ cultural skills, and stigma reduction to help reduce mental health care disparities. These findings are significant to lowering the gap in practice and can be used by the entire health care system to improve mental health care, thereby leading to a positive social change. Implementing these strategies would benefit patients, families, their communities, and the entire health care delivery system.

Bakgrund: Stigmatisering av patienter med psykisk ohälsa kan leda till en barriär för adekvat bemötande, vård och behandling. I takt med att primärvården övertar mer ansvar för den psykiatriska vården, blir det allt vanligare för den grundutbildade sjuksköterskan att möta patienter med psykisk ohälsa inom primärvården. Det är därför viktigt för alla sjuksköterskor att förstå stigmatisering och dess möjliga inverkan på patienter med psykisk ohälsa, för att kunna ge vård som är respektfull, rättvis och icke-dömande. Syfte: Att belysa patienters, med psykisk ohälsa, upplevelser och erfarenheter av stigmatisering inom hälso- och sjukvården. Metod: En litteraturstudie med kvalitativ ansats. Litteratursökningar gjordes i databaserna Cinahl och Psycinfo. Utvalda studier kvalitetsgranskades utifrån SBU:s granskningsmall för kvalitativa studier. Efter granskning kvarstod tolv artiklar vilka analyserades utifrån Popenoe’s analysmodell. Resultat: Resultatet presenteras genom en huvudkategori - Stigmatisering av psykisk ohälsa och tre underkategorier; Jag är inte bara min psykiska ohälsa, Känsla av att vara mindre värd och Avsaknad av terapeutisk allians. Konklusion: En personcentrerad vårdmodell är avgörande för att minska stigmatisering av patienter med psykisk ohälsa. Att främja patienters självbestämmanderätt och delaktighet stärker patienternas förmåga och möjlighet att ta ansvar för sin hälsa. / Background: Stigmatization of patients with mental-illness creates a barrier that might affect their care and treatment. Since primary care has an increasing responsibility for psychiatric care, it’s common for primary care nurses to encounter patients with mental ill-health in outpatient settings. It’s therefore important for all nurses to understand stigma and its impact on mental health patients in order to provide respectful, equal and non-judgmental care. Aim: The aim of the study is to describe patients with mental ill-health, experiences of stigmatization in healthcare. Method: A literature review with qualitative method. Searches for literature were conducted in Cinahl and Psycinfo databases. The selected studies were quality reviewed by SBU's template for review of qualitative studies. After the quality review, twelve articles remained, which were analyzed based on Popenoe's analysis model. Result: The result were presented by the main category - Stigmatization of mental ill-health and the three subcategories; I’m not only my mental ill-health, A feeling of being less of value and Lack of therapeutic alliance. Conclusion: A person-centered care model is crucial to reduce the stigmatization of patients with mental ill-health. Promoting patients' right to self-determination and participation strengthens the patient's ability and opportunity to take responsibility for their own health.