ABSTRACT
OBJECTIVE: The announcement of a resistance to treatment in pediatric oncology occurs within the framework of an established parent-pediatrician relationship. The aim of this study was to understand the parents' experience of this announcement and the relational and communicational factors likely to impact it. METHOD: A mixed-methods study was conducted in a pediatric oncology department with 15 parents of a child with treatment-resistant cancer, with an average age of 40.8years. The parents completed three questionnaires to assess their anxiety and depression (HADS) and their information needs (EORTC - QLQ Info 25 and PTPQ). Semi-structured interviews were conducted and a content analysis was performed. RESULTS: The majority of parents have "suspected" or "proven" anxiety and/or depressive disorders. The experience of this announcement was influenced by the quality of the parent-pediatrician relationship, the perceived quality of the management, the anticipation of the announcement, the context of the announcement, and the experience of previous announcements. The parents interviewed were very satisfied with the informational exchanges. This satisfaction was underpinned by honest communication and by the responsiveness and availability of the pediatricians. DISCUSSION: The establishment of a relationship of trust between the family and the pediatrician throughout the course of care plays a major role in the parents' experience of the announcement of resistance to treatment.
Subject(s)
Neoplasms , Parents , Child , Humans , Adult , Medical Oncology , Neoplasms/therapy , Surveys and QuestionnairesABSTRACT
Announcing drug resistance is complex for pediatric oncologists because they have to provide a substantial amount of medical information while taking a major emotional impact on the parents into account. This study aimed to understand how these announcements are currently conducted and how pediatric oncologists adapt the information given to each family in situations where there is resistance to treatment. Semi-structured interviews were conducted with 15 pediatric oncologists (66.7% women, aged 44.7 years on average). Interviews were audio-recorded and a thematic content analysis was conducted. Announcements of drug resistance are stressful, as they are not well codified, difficult to anticipate, and pediatric oncologists have many issues about how best to behave and which words to choose. The majority of them believe that the severity, or even the incurability of the disease, and the offer of a therapeutic alternative are essential components of the information to pass on. Pediatric oncologists describe how they adapt their communication to each family, particularly in relation to parents' questions, and also to their reactions during the announcement. They also need to adapt to the prior acquaintance they may have with the families, and to previous exchanges. Finally, pediatric oncologists acknowledge their subjectivity when estimating the parents need in terms of information. Understanding the course of these announcements gives us another point of view at the issues involved in this announcement. Proposals to support pediatric oncologists in this difficult moment can be suggested: communication support tool, work in pairs and discussion group.
Subject(s)
Neoplasms , Oncologists , Child , Humans , Female , Male , Professional-Family Relations , Parents/psychology , Neoplasms/therapy , CommunicationABSTRACT
INTRODUCTION: The announcement of treatment resistance is a key moment in the management of children treated for cancer. Although nurses are present at various stages of this announcement, few studies have examined their role and experience. This study proposes to enhance understanding of the experience of nurses at this time of the pediatric cancer trajectory in France. METHOD: A qualitative study was conducted in two pediatric oncology departments. Semi-structured research interviews were conducted with seven pediatric nurses (five women) with an average age of 36.9 years. RESULTS: Nurses report not being systematically present during announcements of treatment resistance but being present with the families before and after these announcements. Nurses described their role at this point in the management process as multifaceted. The emotional burden associated with these announcements is significant: nurses must manage their own emotions when faced with the discovery of resistance to treatment, those of the families, and must often answer difficult questions about the prognosis or end of life. In this context, teamwork is an important support. DISCUSSION: Better awareness and recognition of the role of nurses and the associated emotional burden would enable them to fully carry out their missions.
Subject(s)
Neoplasms , Nurses , Child , Female , Humans , Adult , Medical Oncology , Qualitative Research , Palliative Care , Neoplasms/therapyABSTRACT
PURPOSE OF REVIEW: This literature review sets out to summarize knowledge on the impact of question prompt lists (QPLs) on patient-physician communication in oncology and to provide an account of current research on the development, adaptation, and implementation of this type of communication tool. RECENT FINDINGS: Provided with a QPL, patients seem to ask more questions, in particular on sensitive issues like those around the end-of-life period and they recall the information provided better. There is a need to adapt QPLs, taking account of divergences in attitudes towards illness, participation in decision-making, and discussions about the illness prognosis across cultures. QPLs may also need to be tailored to specific concerns of patients at the different stages in the care trajectory and to the particularities of each cancer type. These adaptations contribute to the effectiveness of the tool because they make it possible to tailor it to the challenges and constraints experienced in clinical practice. SUMMARY: QPLs are designed to enhance patients' communication with their physicians. Further research is required to develop QPLs suited to each cultural and clinical setting, involving health professionals so as to facilitate the implementation of these tools in routine practice.
Subject(s)
Neoplasms , Patient Participation , Communication , Humans , Neoplasms/therapy , Physician-Patient Relations , Surveys and QuestionnairesABSTRACT
Psycho-oncology is evolving in line with oncology progress and increasing complexity, but also with change in cancer care organization. Alongside the more traditional psycho-oncological interventions, such as the support or verbal psychotherapy of various inspirations (psychodynamic, integrative, systemic, existential) and body-mediated approaches, that allow the patient to be accompanied throughout his/her cancer care trajectory, psycho-oncology is now benefiting from the development of more structured interventions, often brief and targeted at a specific situation or symptom. This article reviews three of these new psychotherapeutic approaches, which are largely developed in the Anglo-Saxon world: the management of fear of recurrence by CBT third wave strategies, ACT therapy or, more recently, EMDR to answer to psychotraumatic situations. We describe here the principles, the main indications in oncology patients and the expected clinical benefits. It also presents tools such as Questionnaire Prompt Lists for optimizing the communication between patients and health professionals, which constitute a psychotherapeutic intervention by itself.
Subject(s)
Neoplasms , Psycho-Oncology , Female , Humans , Male , Medical Oncology , Neoplasms/therapy , Psychotherapy , Surveys and QuestionnairesABSTRACT
BACKGROUND: Most cancer-related deaths result from disseminated diseases that develop resistance to anticancer treatments. Inappropriate communication in this challenging situation may result in unmet patient information and support needs. Patient communication aids such as question prompt lists (QPLs) may help. OBJECTIVE: This study aims to develop and pilot-test a specific QPL in the following two contrasting clinical contexts in France after cancer resistance has developed: triple-negative and luminal B metastatic breast cancer (MBC) and metastatic uveal melanoma (MUM). METHODS: A sequential study design with a mixed methods collaborative approach will be applied. The first step aims to build a specific QPL. Step 1a will explore oncologist-patient communication issues from oncology professionals' interviews (n=20 approximately). Step 1b will appraise information and support needs experienced by patients with MBC or MUM both quantitatively (n=80) and qualitatively (n=40 approximately). These data will be used to develop and pilot-test a QPL specific to patients with cancer experiencing initial or acquired resistance to treatment. We expect to obtain a core QPL that comprises questions and concerns commonly expressed by patients with resistant cancer and is complemented by specific issues for either MBC or MUM cancer sites. In step 1c, 2 focus groups of patients with any type of metastatic cancer (n=4) and health care professionals (n=4) will be conducted to revise the content of a preliminary QPL and elaborate an acceptable and feasible clinical implementation. In step 1d, the content of the QPL version 1 and implementation guidance will be validated using a Delphi process. Step 2 will pilot-test the QPL version 1 in real practice with patients with MBC or MUM (n=80). Clinical utility will be assessed by comparing responses to questionnaires administered in step 1b (QPL-naive historical control group) and step 2 (QPL intervention group). RESULTS: This study received grants in March and December 2019 and was approved by the French national ethics committee in July 2019. As of October 2021, interviews with oncology professionals have been conducted and analyzed (N=26 to reach saturation), and 39 and 27 patients with MBC and MUM, respectively, have been recruited. CONCLUSIONS: A clinically and culturally tailored QPL is expected to facilitate patients' participation in consultations, improve oncologists' responses to patients' information and support needs, and thus foster patients' psychological adjustment to the diagnosis and follow-up of cancer resistance to treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04118062; http://clinicaltrials.gov/ct2/show/NCT04118062. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26414.
ABSTRACT
Breaking bad news in pediatric oncology covers widely diverse clinical situations. The aim of this study was to highlight the specificities of the announcement of treatment resistance as perceived by pediatric oncologists, particularly in comparison with the disclosure of a cancer diagnosis. Semi-structured interviews were conducted in two pediatric oncology departments in France, with 15 pediatric oncologists (66.7% were women, aged 44.7 years on average). Interviews were audio-recorded and transcribed and a thematic content analysis was conducted. Most pediatric oncologists reported emotional difficulties in announcing treatment resistance. Some of them mentioned a personal need to accept resistance to treatment and to mourn the child's chances of recovery, and reported feelings of medical failure. This disclosure was considered more difficult than the announcement of the cancer diagnosis because it was associated with less optimism and more complex and fewer therapeutic options. The attachment bond created with families in the course of treatment seemed to exacerbate the emotional difficulties associated with this announcement. In conclusion, resistance to treatment has an impact on prognosis. It makes it more uncertain. Its announcement for pediatric oncologists is a turning point that affects their initial optimistic perspective. Their emotional difficulties are accentuated by the attachment that has been created with the families. Focusing on difficulties experienced by pediatricians could help to improve parent-pediatrician communication.
Subject(s)
Oncologists , Physician-Patient Relations , Adult , Child , Communication , Emotions , Female , Humans , Medical Oncology , Oncologists/psychologyABSTRACT
Sport : is it a protective factor or a factor of exposure to alcohol risk ? This article provides an update on the nature of the links between athletes and alcohol consumption in order to better identify and understand the risks associated with the use of alcohol in the athlete population. All this by specifying the ways in which participation in sports could prove to be protective with respect to such risks and to answer to the stakes posed by this public health question. Different characteristics of the athlete population (intensity of participation, nature of sports participation, etc.) were taken into account in order to answer the question « How do sports affect your health? ¼ and to understand the characteristics of alcohol-related disorders in athletes with reference to the place occupied by the alcohol substance in the athlete's career. Beyond alcohol consumption, it has been possible to emphasize the ambivalent protective and vulnerabilizing character of sports participation on health, be it at the cultural, psychological, physiological and social level. On the basis of these elements, this article proposes a discussion on prevention programs and interventions for alcohol misuse in the sports population.
Le sport : facteur de protection ou d'exposition au risque alcool ? Cet article fait le point sur la nature des liens qu'entretiennent la pratique sportive et la consommation d'alcool afin de mieux identifier et comprendre les risques liés aux usages de l'alcool en population sportive. Tout cela en précisant les modalités selon lesquelles la pratique sportive pourrait s'avérer protectrice vis-à-vis de tels risques et pour répondre aux enjeux posés par cette question de santé publique. Différentes caractéristiques de la population sportive (intensité de pratique, nature de la pratique, etc.) ont ainsi été prises en compte afin de répondre à la question « Le sport est-il bon pour la santé ? ¼ et d'appréhender les particularités des troubles liés à l'usage de l'alcool chez les sportifs en référence à la place qu'occupe la substance alcool dans le parcours du sportif. Au-delà de la consommation d'alcool, le caractère ambivalent, à la fois protecteur et vulnérabilisant, de la pratique sportive sur la santé a alors pu être souligné, que ce soit sur le plan culturel, psychologique, physiologique ou social. Sur la base de ces éléments, cet article propose une discussion relative aux modalités de prévention et de prise en charge des mésusages de l'alcool au sein de la population sportive.
