Disparities in “Difficult Relationships” Between Clinicians and Parents of Children With Cancer: How We Mend and Move Forward
Menée aux Etats-Unis par enquête auprès de 400 parents d'enfants atteints d'un cancer et de 80 professionnels de santé (médecins oncologues et infirmiers), cette étude analyse les enjeux associés aux relations parents-médecins dans le domaine de l'oncologie pédiatrique
Although difficult conversations are well-studied in pediatric oncology, difficult relationships are less understood. This is important because difficult relationships between patients, their caregivers, and clinicians are common, may break therapeutic alliances, and contribute to clinician burnout and family distress. What makes a parent-clinician relationship difficult? What is the parent’s perspective? What is the clinician’s perspective? Are some families more at risk to experience these challenges than others? How can we repair a damaged relationship?In a rigorous survey-based investigation of parents of children with cancer and their clinicians (physicians and nurse practitioners) at 2 large academic centers, Mack and colleagues provide valuable new-found answers to some of these questions. Specifically, investigators invited parents to identify their primary oncology clinicians and then both parties completed versions of a survey querying relationship challenges. Based on the group’s previous work defining key factors of challenging relationships, the parent version focused on perceptions of respect, trust, and listening. Challenging relationships for parents were defined as any single response to a question in the lowest 2 of 4 categories. For example, to the question “How much do you trust your child’s oncology provider?” a response of “not at all” or “somewhat” was categorized as a challenging relationship. The clinician survey focused on perceived time and effort required to deliver high quality care. A relationship was defined as challenging by clinicians if a single response included the most negative 3 ratings on a scale from 1 (“not at all”) to 6 (“a great deal”). For example, a negative response to “How time-consuming has it been to work with this patient’s parents?” was considered challenging. Parent surveys also included validated instruments to assess symptoms of anxiety and depression, and both parents and clinicians self-reported demographic data such as race, ethnicity, and level of educational attainment. (...)
JAMA Network Open , commentaire en libre accès, 2020