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  • Temozolomide br The interviewees in this survey had a

    2020-07-28


    The interviewees in this survey had a variable appreciation of the duration of the interview. Can the emotional upheavals, the anger or consternation following the announcement of the diagnosis allow for an objective assessment of the duration of the interview? The optimal duration of the announcement varies according to the authors. Delaporte recommends a long consulta-tion where the listening time is important; Hoerni proposes short and repeated interviews because of the state of sedation engendered by the announcement, which reduces the ability to memorize [16]. The authors insist on the necessity of repeating the information several times to gradually change the patient’s representation of cancer and make the patient integrate this reality. The announcement is inscribed in the moment and then in the continuity of the encounter [10]. The parents interviewed
    Please cite this article in press as: Couitche´re´ L, et al. Analysis of diagnosis announcements in Abidjan pediatric oncology unit 2 years after introduction of the African Pediatric Cancer Announcement Guideline. Archives de Pe´diatrie (2019), https://doi.org/10.1016/ j.arcped.2019.06.006
    agreed with this notion, and in the free comments section they insisted on the need to repeat the interviews. To achieve this, the information must be relayed in a holistic way by the care team [10], and therefore it is essential to have traceability of the announcement and the terms used. Needless to say, our team must integrate this practice to improve the information provided. The announcement must be made in an Temozolomide of exchange so as to facilitate the understanding of the given message. In the present survey, 52.38% of the accompanying persons asserted that they did not have the opportunity to express themselves and 22.22% pointed out communication problems as obstacles. The communication gaps are a barrier to establishing good therapeu-tic relationships. An ambiguous or incomplete communication leaves the patient badly prepared for the future and affects the patient’s adjustment reactions. For Rogers, a patient-centered method gives positive results; it is the patient who knows what makes him/her suffer and how to move forward [13]. It is therefore necessary to allow the patient to express themselves and to be actively listening to the patient [12]. The announcement is above all the initial time to establish a relationship of trust based on listening to the patient, on their expectations and anxieties [10]. Buckman insists on active listening, that is, the need to remain silent, listen to the patient while showing interest in what he/she says [16]. It is necessary Temozolomide to maintain eye contact as soil shows interest [16]. The African guide provides an announcement protocol that has similarities with the protocol ‘‘Breaks’’ [13]: it draws up the framework; insists on empathy, distance to be respected, and active listening; gives the information in a specific order; and proposes to leave space for parents at the beginning and at the end of the interview [17]. This communication skill is usually gained through trial and error or observation of senior colleagues [13,18]. The other obstacles reported in the survey were the negative experiences of the parents (44.44%) and the incomprehensible medical terms (33.33%). The information provided must be accessible, formulated in clear language, so as to enable parents to become involved in the decision-making process. The physician’s speech must be adapted to the patient. It is necessary to formulate short and easily understandable sentences [15,19].
    4.2. Information to the child
    The doctor-patient relationship in the specific case of the child is a triangular relationship. The parents, the child, and the doctor form a trio that is central at the time of announcing the diagnosis as well as at key moments of the treatment. The child is and must remain at the center of the announcement. When the announce-ment is first made to the parents, the child should remain in the central position even if the information is not primarily targeted to him/her [4]. The right of the child to information is emphasized by many charters and conventions: charters of the rights of children, the rights of hospitalized children, the UNESCO Agreement on the Rights of the Child of October 20, 1989 (article 3, paragraphs 2 and 3) in use since September 2, 1990. Everything is focused on the recognition of the place of the child in receiving information and participating in the decision-making process
    [20]. However, the child’s right to know must take into account the complexity of the situations encountered, as well as the specificities and needs of each child, according to their age, development, and history [4,20]. Our survey showed that very few children were able to benefit from a diagnostic announce-ment (2 cases, i.e., 2.89%), and no child participated in the decision-making process. Andre´ et al. in their survey on the place of the child in pediatric decision-making reported that 82% of pediatric residents informed the child, but the partnership with the child was weakened when it came to asking for the child’s