[Reaching a team consensus in pediatric oncology when treatment proves ineffective].
Modern treatments are able to cure 3/4 of paediatric cancers, but on another hand there is still a too high number of patients which will enter a resistant phase and test the ability of the medical and nursing team to face together the new modalities of care. At diagnosis, the reasonable hope to cure the child and the exciting feeling to be endued with a repairing mission strengthen among the team both the self-esteem and a rational and emotional consensus. Conversely, at the time of relapse or resistant disease, the feeling of a failure, added to anxiety and reciprocal aggressiveness, will contradictorily affect the group. In this atmosphere of loss of control of reality and emotions, elaborating new priorities of care is mandatory: medical positions have of course to be in keeping, but this is not enough since the nursing team has, through sharing information and feeling, to give their cure project of the child's cancer as lost while retaining and expanding their ability to care the child with cancer. Thanks to an over-investment of the symptomatic, psychological, and affective help support to the child, the nursing team will succeed in regaining this self-esteem absolutely necessary to their own professional survival. Consensus in the team is ultimately linked to its empathic ability of exchanging with the families which in turn results in giving them guidelines for the last weeks and months of life and helping them to be less emotionally unprovided when bereavement time has come: a pedagogy of the continuity of care is thus taking place which, equally distant from forsaking and therapeutic relentlessness, chooses to give up the idea of curing in order to go on caring.
Zucker
J M
JM
Département d'oncologie pédiatrique, Institut Curie, 26, rue d'Ulm, 75005 Paris, France. Jean-Michel.Zucker@curie.net
D000328:Adult; D001601:Bereavement; D002648:Child; D002669:Child Welfare; D003657:Decision Making; D004992:Ethics, Medical; D005192:Family Health; D006801:Humans; D007400:Interprofessional Relations; D008495:Medical Oncology / Q000639:trends*; D009723:Nurse-Patient Relations; D010166:Palliative Care; D010348:Patient Care Team; D018802:Patient-Centered Care; D010372:Pediatrics / Q000639:trends*; D010817:Physician-Patient Relations; D011379:Prognosis