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  • br Table br Characteristics of children

    2020-08-12


    Table 2
    Characteristics of children (N = 69).
    Characteristics N (%)
    Sexe
    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
    3.3. Time dedicated to the announcement
    3.4. The person making the announcement
    3.5. Content of the announcement
    3.6. Obstacles to information
    The most frequently cited obstacles to information (Fig. 1) were: (a) the negative experiences (16/36 cases, 44.44%) of the parents related to the representations of the disease, to the feelings elicited, and to their economic situation, which could not allow them to support the cost of treatment of their child; (b) the medical terms (12/36, 33.33%); and (c) communication problems, as eight accompanying persons (8/36 cases, 22.22%) asserted that physi-cians did not communicate much and gave brief explanations. As shown in Fig. 1, the other obstacles (2/36 cases, 5.55%), which were rarely mentioned, were due mainly to the lack of answers to questions asked.
    3.7. Observations of the parents regarding the announcement
    Of all the interviewees, 49 parents (49/63 cases, 77.77%) stressed that the announcement was made with empathy; however, the person giving the information had not returned to the main points of the interview (12/63, 19.05%) and had not
    Fig. 1. Obstacles to parent information.
    3.8. Information to the child
    3.9. The decision-making process
    The parents had given their consent for the treatment in 66.66% (42 cases) of cases, but no child had participated in (i.e., the choice of treatment) the decision-making process.
    3.10. Suggestions made by the parents
    4. Discussion
    The present survey reveals that the majority of the accompa-nying persons benefited from a diagnostic announcement and were able to participate in the decision-making process. The time of announcement constitutes the first stage of the care relation-ship, and the confidence established during this stage conditions the relationship during the course of treatment and follow-up [9– 11]. To formulate the announcement, it 75899-68-2 is necessary to adapt to the individual patient and the circumstances [12].
    4.1. Characteristics of the announcement of the diagnosis and treatment
    The announcement is part of a specific treatment plan that should be explained [10]. It requires a defined framework and preliminary preparation with several components: knowledge of the patient’s medical record; the psychological, physical, and emotional state of the patient; anticipation of answers to possible questions; the cultural context; and the removal of any physical barrier that can interfere with eye contact [13]. The announcement has to be made in a quiet place, shielded from untimely interruptions [7,10,14]. In the survey conducted prior to the implementation of the African Pediatric Cancer Guide, 90% of parents had indicated their preference for the physician’s office [5],
    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
    Fig. 2. Sources of information for the child.
    and in this survey the announcement had been made in an office in 38.69% of the cases. The office, being quiet, can be a suitable place where the physician can listen to the patient; however, the physician can also be interrupted at any time if there is no relay, for example, a secretary [15]. Making the announcement at the patient’s bedside and in the treatment room, which occurred in three cases in our survey, is far from meeting these criteria. The main source of information in all surveys, as in our own, is the physician. The authors agree that information needs to be provided by the specialist, health workers who know the disease best, and who can answer the families’ questions [4,14]. Previous surveys in Africa showed that 100% of Egyptian mothers and 95% of parents of children attending FAGPO units preferred ‘‘the announcement of bad news’’ to be made by the family physician or attending physician [5,7]. In almost one quarter of the cases, the announce-ment was made to a third party with or without the presence of the parents. This model of disclosure can be seen in some African
    Fig. 3. Obstacles to information for children.
    cultures; the announcement of bad news is made in the presence of the oldest male member of the family or simply to someone who is responsible for transmitting the information. This also applies in some Asian societies (China, Japan) where the family is more important than the individual. In Yoruba African society, important information about life is given to the guardians of the oral tradition (healers, religious leader), whose words are considered to be an oracle and have the support of everyone [6]. The information, received mainly from the physician, very often included the name of the disease, the word ‘‘cancer,’’ and the treatment plan for the child [10]. To announce an illness like cancer requires using the most suitable word [10]. As the results of this survey show, the words commonly used are ‘‘cancer’’ and ‘‘tumor’’ [16]. The risk of death was addressed in only 20% of cases. A think-tank on the announcement of serious pediatric illnesses comprising relatives and caregivers advocates not addressing the serious complications of the disease and the risk of death during the announcement of the diagnosis, except in special cases. Death is a taboo subject in modern society.