[Emotions Associated with Breaking Bad News in Pediatric Oncology and Parents-Pediatrician Communication: A Status Report]

[The announcement of treatment resistance in pediatric oncology: Understanding parents' experiences and influencing factors with a mixed methodology]

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.

How do you tell parents whose child has cancer that the treatment has failed: A qualitative study on pediatric oncologists' practices

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.

[Announcing treatment resistance in pediatric oncology: A qualitative study of nurses' experiences]

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.

Question prompt lists to improve communication between cancer patients and healthcare professionals

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.

Réflexions cliniques et éthiques à partir d’une recherche menée en psycho-oncologie sur la communication lors de l’annonce de l’échec d’un traitement antitumoral

Cet article rend compte des divers questionnements cliniques et éthiques apparus au cours de notre recherche en psycho-oncologie. Celle-ci porte sur la communication entre les oncologues et leurs patients, et les pédiatres-oncologues et les parents d’enfants malades à un moment particulier de la prise en charge : l’annonce de la résistance au traitement antitumoral et l’absence d’alternative curative connue. La mise en place d’une telle étude nécessite de prendre en compte les aspects émotionnels et psychologiques en jeu. Dans un premier temps, nous présentons les interrogations portant sur le recrutement des participants : comment et quand les contacter ? Par la suite, nous questionnons le potentiel impact de cette recherche pour les participants : quels mots utiliser et quelles questions aborder ? Enfin, nous revenons sur les précautions à prendre dans l’interprétation et la transmission des résultats : quelles sont les incidences des choix méthodologiques ? À chaque étape, nos réflexions sont illustrées par des exemples concrets. Cet article met en exergue la nécessité de la réflexion à la fois clinique et éthique dans le domaine de la recherche en psycho-oncologie.