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.

摘要

儿科肿瘤学中的坏消息涵盖了广泛多样的临床情况。本研究的目的是强调儿科肿瘤学家认为宣布治疗耐药的特殊性，特别是与癌症诊断的披露相比。在法国的两个儿科肿瘤科进行了半结构化访谈，共有 15 名儿科肿瘤科医生（66.7% 为女性，平均年龄 44.7 岁）。采访被录音和转录，并进行了主题内容分析。大多数儿科肿瘤学家报告在宣布治疗抵抗时存在情绪困难。他们中的一些人提到了个人需要接受对治疗的抵抗并为孩子的康复机会感到悲痛，并报告了医疗失败的感觉。这一披露被认为比癌症诊断的宣布更困难，因为它与更少的乐观和更复杂和更少的治疗选择有关。在治疗过程中与家人建立的依恋纽带似乎加剧了与此公告相关的情感困难。总之，对治疗的抵抗对预后有影响。它使它更加不确定。它对儿科肿瘤学家的宣布是一个转折点，影响了他们最初的乐观看法。与家人建立的依恋加剧了他们的情感困难。关注儿科医生遇到的困难有助于改善父母与儿科医生的沟通。