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Open Access Clinicians' Routine Use of Non-disclosure: Prioritizing "Protection" over the Information Needs of Adolescents with Cancer Le recours systématique à la rétention d'information chez les cliniciens : comment la volonté de protéger nuit aux besoins en information des adolescents atteints de cancer

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Abstract:

This is a qualitative study of clinicians' use of partial information disclosure and its consequences for adolescents' ability to participate in the management of their cancer treatment. A total of 17 pediatric cancer patients, their families, and clinicians were observed during 15 months of ethnographic fieldwork in a hospital in Barcelona, Spain. Eighty-six hours of videotaped medical and social activities were analyzed micro-interactionally and longitudinally. Clinicians used 4 strategies to evade direct answers to adolescents' questions: contingent answers, narrow answers, non-answer responses, and question forestalling. Information withholding by clinicians was shown to greatly limit adolescents' ability to participate in the management of their treatment and to be ineffective in its implicit goals of protecting the patient and containing uncertainty and anxiety. The author concludes that if clinicians were to integrate adolescents' individual information needs into their communicative practices they would be able to better assess what information to disclose as well as how and when to disclose it.

French
La présente étude qualitative porte sur le recours à la communication partielle des renseignements chez les cliniciens et ses conséquences sur la capacité des adolescents à participer à la gestion de leur propre thérapie contre le cancer. L'auteur a observé pendant dix-huit mois, dans le cadre d'une étude ethnographique menée dans un hôpital de Barcelone, dix-sept jeunes patients atteints de cancer, leurs proches et les professionnels qui les traitaient. Il analyse d'un point de vue microsociologique et longitudinal les interactions observées au cours des activités médicales et sociales qui se sont déroulées pendant les 86 heures d'enregistrements vidéo qu'il a recueillis. Il constate que les cliniciens font appel à quatre stratégies pour éluder les questions directes posées par les adolescents : réponses évasives; réponses circonscrites; réponses qui n'en sont pas; et anticipation des questions. Selon lui, la rétention d'information limite grandement la capacité des adolescents de participer à leur propre thérapie; même si ses buts implicites sont de protéger le patient et de réduire l'incertitude et l'anxiété, elle ne les atteint pas. S'ils tenaient compte des besoins individuels en matière d'information, conclut l'auteur, les cliniciens sauraient mieux évaluer quels renseignements divulguer, comment s'y prendre et à quel moment intervenir.

Keywords: CHILDREN AND ADOLESCENTS WITH CANCER; COMMUNICATION; DISCLOSURE; INFORMATION NEEDS; TRUTH-TELLING; UNCERTAINTY

Document Type: Research Article

Publication date: December 1, 2007

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