Quelle perception les praticiens ont-ils de l’annonce de mauvaises nouvelles en oncologie ? Analyse qualitative du vécu et des stratégies de régulation émotionnelle

Le travail de l’interprète en consultation d’annonce : une étude de cas

Annoncer le diagnostic de cancer impose un cadre précis, a fortiori lorsqu’il s’agit de patients migrants non francophones. Dans ce contexte, la présence d’un interprète soulève des questions spécifiques : quelle est sa place dans le dispositif d’annonce ? Comment sa présence influence-t-elle la communication médecin–patient ? Traduire le diagnostic revient à l’annoncer à un patient qui l’entend pour la première fois ; il en résulte des effets émotionnels chez l’interprète, peu étudiés dans la littérature. À partir d’une double expérience de psychologue et d’interprète, les auteurs de l’article analysent la singularité de ces effets lors de l’annonce du cancer à une femme d’origine arménienne.

[An interview guide for screening for psychological pain in oncology]

An interview guide has been introduced with patients treated in oncology in order to assess their psychological pain. It helps to structure the nurse interview. It also combines the identification of the patient's psychological needs with the creation of an opportunity to talk, thereby initiating a help relationship.

Affective science and avoidant end-of-life communication: Can the science of emotion help physicians talk with their patients about the end of life?

Despite believing end-of-life (EOL) discussions with patients are important, doctors often do not have them. Multiple factors contribute to this shortfall, which interventions including reimbursement changes and communication skills training have not significantly improved to date. One commonly cited but under-researched reason for physician avoidance of EOL discussion is emotional difficulty. High occupational demand for frequent difficult discussions may overload physicians' normal emotional functioning, leading to avoidance or failure. We propose that cognitive, behavioral, and neuroscience evidence from affective science may offer helpful insights into this problem. Data from other populations show that strong emotion impairs cognitive performance and multiple demands can overload cognitive resources. We discuss several affective processes that may apply to physicians attempting EOL discussions. We then discuss selected interventions that have been shown to modify some of these processes and associated behavioral outcomes. Evidence for change in behavioral outcomes of interest includes performance and mood enhancement in healthy populations. We suggest that such mechanistically-targeted interventions may be hypothesized to help decrease physician avoidance of EOL discussion. Physicians may be motivated to adopt such interventions in order to enhance normal emotional functioning to meet supra-normal occupational demand. We propose this as a promising area of future study.