Focus on a European project

The aim of this project funded by the Horizon Europe¹ program is to test, in seven different countries (England, Scotland, France, Italy, Denmark, Norway, Czech Republic), a palliative rehabilitation intervention for patients with advanced cancer. This approach is unique in that it is based on goals defined not by doctors, but by the patient themselves. "It's the person who indicates what will improve their quality of life and what we're going to focus the treatment on. The objective may be, for example, to manage to pick up one's newspaper, or to receive one's family. What counts is what's important to her," explains Guillaume Economos, a physician in the palliative care department at Hospices Civils de Lyon and coordinator of the INSPIRE project.

This intervention is organized over an 8-week period. The first session involves taking stock of the person's abilities and incapacities, as well as their wishes. During the following sessions, we set up an action plan so that she can achieve this goal on her own, and then we take stock. "The idea is to empower the patient as much as possible in their living environment, whether at home or in hospital. If, for example, he's suffering from a pleural effusion and wants to be able to continue going to the Maison de la Presse, we work out with him how to get there, which bench to stop on to do breathing exercises, etc. ", explains Julia Romeyer, occupational therapist and doctoral student.

This type of rehabilitation is not one of the treatment options classically recommended for patients with advanced cancer. It's recommended in Norway, and practiced in England and Scotland in certain institutions, but in Denmark, France, Italy and the Czech Republic, it doesn't exist at all. Hence the interest in testing this approach and demonstrating its benefits, so that we can then advocate with public authorities to integrate it into care pathways.

The INSPIRE project is looking not only at the effectiveness of palliative rehabilitation, but also at the possibility of implementing it in different countries. Indeed, from one to another, culture, acceptability and conditions of application differ. The team at Hospices Civils de Lyon has developed an assessment tool with two questionnaires, one for patients (before and after the intervention) and the other for healthcare professionals (nurses, orderlies, managers, rehabilitation specialists, department heads, doctors, etc.). The latter includes questions on feasibility: cost, team size, sustainability over time, etc. All project partners will test the palliative rehabilitation protocol and administer these questionnaires. All the results will then be analyzed by the Lyon team.

The Hospices Civils de Lyon team is also coordinating the INSPIRE¹ project. Getting the seven project partners to work together represents not only a huge administrative burden, but also an effort of cultural understanding. "The first difficulty is linguistic: everyone has to communicate in a language that is not their own, while we all need to have access to the same information," notes Guillaume Économos. "To give just one small example, the degree of formalism in e-mails differs from one country to another. In reality, not everyone has the same way of doing research". It is necessary to understand how each country works in terms of care pathways and funding routes. Publication also raises questions, insofar as the authors' position in the list of signatories is not valued in the same way in different countries.

Each partner has different responsibilities and takes charge of a part of the project: we speak of "work packages" or work packages. However, the European Commission requires regular deliverables to check that everything is running smoothly. The Hospices Civils de Lyon team called on a specialized project engineering company³ to manage deadline reminders to the various partners and all the administrative work. "I strongly recommend using this type of outside service provider," says Guillaume Economos, "as hospital DRCI⁴ generally don't have sufficient resources to take on these missions. "Finally, participation in a European project requires the organization of a great many meetings, both face-to-face and remotely: every two weeks for the coordination team, once a month for each work package, quarterly for scientific progress and coordination, not to mention the meetings of external committees that provide methodological and ethical advice, or those with the European Commission.

So many particularities to take into account before committing to a European project. In fact, it takes around six months to build a project and submit an application. "You shouldn't apply lightly, there are many elements presented as optional in the application that are in fact mandatory, such as racial, sex and gender equality for access to intervention, or ethical self-evaluation", clarifies Guillaume Economos.

1. This represents €2,725,301 for the period 2022-2026. Within this budget, €578,252.5 is allocated to the hospices civils de Lyon
2. The consortium initially built around King's College London is finally, due to Brexit, led by Hospices Civils de Lyon.
3. There are relatively few companies of this type in France, but it is practiced abroad.
4. Direction of clinical research and innovation

Contacts:
Julia ROMEYER or Guillaume ECONOMOS
julia.romeyer@chu-lyon.fr, guillaume.economos@chu-lyon.fr
Palliative Care Department, Hôpital Lyon Sud
165, chemin du grand Revoyet
69495 Pierre-Bénite

For more information:
https://www.plateforme-recherche-findevie.fr/projets/integrated-short-t...
https://www.plateforme-recherche-findevie.fr/projets-europeens/inspire
https://palliativeprojects.eu/inspire/