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1.
J Surg Educ ; 81(6): 858-865, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38679493

RESUMO

INTRODUCTION: Training to disclose bad news in a pluridisciplinary format facilitates communication and improves learning. There are many different debriefing methods described in the literature. The aim of this study was to compare and evaluate the value of final debriefing and microdebriefing with interruptions of the scenario in a simulation program about communication in unexpected complications from perioperative care. METHODS: We conducted a prospective, randomized, single center study between October 2018 and July 2019 in a simulation center. Three scenarios were related to patient or family disclosure of complications which had occurred during gynecologic surgery by a dyad involving 2 residents (a gynecology and an anesthesia resident). All sessions involved 6 residents (3 gynecologist and 3 anesthesiologist). The main outcome measure was the immediate residents' self-assessment of the impact of the course on their medical practice immediately after the session. RESULTS: We performed 15 simulation sessions including 80 residents. Thirty-nine residents were included in final debriefing group and 41 in micro-debriefing group. There was no significant difference on the impact for medical practice between groups (9.3/10 in the micro-debriefing group versus 9.2 in the final debriefing group (p = 0.53)). The overall satisfaction was high in the 2 group (9.1/10 in the 2 groups). CONCLUSION: This study is the first one to compare two debriefing methods in case of breaking bad news simulation. No difference between the 2 techniques was found concerning the students' feelings and short and long-term improvement of their communication skills.


Assuntos
Internato e Residência , Treinamento por Simulação , Internato e Residência/métodos , Humanos , Estudos Prospectivos , Treinamento por Simulação/métodos , Feminino , Masculino , Assistência Perioperatória/educação , Adulto , Ginecologia/educação , Competência Clínica , Anestesiologia/educação , Revelação da Verdade , Educação de Pós-Graduação em Medicina/métodos , Comunicação , Procedimentos Cirúrgicos em Ginecologia/educação , Complicações Pós-Operatórias/prevenção & controle
3.
Bull Cancer ; 109(4): 477-490, 2022 Apr.
Artigo em Francês | MEDLINE | ID: mdl-35256158

RESUMO

The therapeutic arsenal for advanced ALK positive non-small cell lung cancer has been enriched by specific treatments targeting this molecular abnormality, with five molecules available, including lorlatinib, approved since July 2020. This treatment can have side effects common to other tyrosine kinase inhibitors, as well as other less common disorders affecting the central nervous system such as impaired cognitive function, speech or mood. The prevalence of neuro-psychiatric effects under treatment with lorlatinib reported in studies is nearly 40 % with a mild to moderate intensity in most cases. Given the potential impact on patients' quality of life and even on compliance with treatment, it is essential to include their detection during consultations. The main problem is still to have simple screening tools adapted to clinical practice. A multidisciplinary expert panel (pulmonologist, medical oncologist, psychiatrist, neurologist, pharmacist, nurse) therefore met to propose, based on data from the literature and their clinical experience, elements of management in order to detect these cognitive disorders at an early stage and optimize treatment tolerance. The subjects discussed concern screening and assessment tools, the management of side effects, and their prevention. The use of the practical elements proposed by the group could help optimize the identification and management of central nervous system disorders occurring on lorlatinib.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Doenças do Sistema Nervoso Central , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Neoplasias Pulmonares , Aminopiridinas/uso terapêutico , Quinase do Linfoma Anaplásico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Humanos , Lactamas , Lactamas Macrocíclicas/efeitos adversos , Neoplasias Pulmonares/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Pirazóis , Qualidade de Vida
4.
J Gynecol Obstet Hum Reprod ; 50(7): 102062, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33453446

RESUMO

INTRODUCTION: Disclosure of damage related to care is a difficult area of communication due to the physician's feeling of guilt or the fear of liability. The aim of this study was to develop, and to evaluate the impact of an inter-disciplinary simulation program on communication of damage related to care. METHODS: Residents in gynecology/obstetrics and anesthesiology participated in role-playing scenarios of communication of damage related to care. We assessed verbal, non-verbal communication skills and inter-disciplinary relations with a modified SPIKES protocol and with a video analysis with predefined indicators. We evaluated long-term impact of the training at 3-6 months with combining self-assessment and a video analysis on retained knowledge. RESULTS: We included 80 residents in 15 sessions of simulation. Satisfaction regarding the simulation training was high (9.1/10 [8.9-9.3]). The part of the SPIKES protocol "setting up the interview" was the more difficult to apply. Empathic attitude was adopted 80 % of the time in the two scenarios with a life-threatening complication but was less common in the anesthetic one (broken tooth). The residents found interdisciplinary disclosure helpful due to support from the other resident. Immediately after the session, residents reported an important improvement in communication skills and that the session would significantly change their practice. At 3-6 months, reports were still largely positive but less than on immediate evaluation. CONCLUSION: Residents did not master the most important communication skills. The interdisciplinary method to breaking bad news was felt useful.


Assuntos
Relações Profissional-Paciente , Procedimentos Cirúrgicos Operatórios/psicologia , Revelação da Verdade , Adulto , Feminino , Humanos , Internato e Residência/métodos , Masculino , Pessoa de Meia-Idade , Treinamento por Simulação/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos
5.
Nat Rev Clin Oncol ; 17(11): 707-715, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32636502

RESUMO

The optimal duration of therapy in patients receiving immune-checkpoint inhibitors (ICIs) is a new but crucial question that has arisen owing to the observation of durable remissions in >85% of patients with metastatic melanoma who stop receiving an anti-PD-1 antibody after a complete response (CR). Long-term treatment-free remissions have also been seen, albeit much less frequently, in patients receiving ICIs for other forms of cancer who have a CR. Despite these promising observations, the optimal duration of treatment with ICIs remains unknown and requires further investigation in randomized controlled trials. In the absence of prospective data, some general criteria to guide the safe cessation of ICIs can be proposed, at least for patients with melanoma, in whom ICI cessation after a confirmed CR and at least 6 months of treatment is generally deemed safe. In this Perspective, we describe the available data on ICI interruption in patients with melanoma and in those with various other cancers. We also address the patient management implications of stopping ICI therapy.


Assuntos
Inibidores de Checkpoint Imunológico/uso terapêutico , Melanoma/tratamento farmacológico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Ensaios Clínicos como Assunto , Humanos , Inibidores de Checkpoint Imunológico/farmacologia , Imunoterapia/métodos , Melanoma/imunologia , Metástase Neoplásica , Estudos Prospectivos , Indução de Remissão , Resultado do Tratamento
6.
Support Care Cancer ; 23(12): 3581-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25894881

RESUMO

PURPOSE: The aim of this study was to explore associations between arthralgia and fear of recurrence in breast cancer patients treated by aromatase inhibitors (AI). METHOD: We sent a set of questionnaires to 100 patients examining their pain characteristics, anxiety (STAI), depression (BDI-SF), quality of life (SF-36), fear of recurrence (FCRI), and representations of AI treatment (ad hoc questionnaire). Nonparametric tests were used to investigate between-group comparisons (arthralgia vs. nonarthralgia) in these domains as well as the associations between arthralgia and fear of recurrence. RESULTS: Of the 77 patients who returned the questionnaires (response rate = 77%), 60 (78%) reported arthralgia. The mean score of fear of recurrence exceeded the pathological threshold in the arthralgia group and was significantly higher than that in the nonarthralgia group (14.8 vs. 10.7, p < 0.01). Significant associations were observed between fear of recurrence and pain intensity (r = 0.274, p < 0.05) and pain relief (r = -0.409, p < 0.05). More than 80% of the total sample declared that they were well informed about the aim of AI, their side effects, and the risk of developing arthralgia. Fear of recurrence did not appear to be associated with representations of AI. CONCLUSION: The study revealed a close relationship between pain intensity and fear of recurrence. In particular, it showed that effective pain management was accompanied by a reduced fear of recurrence. Information, although essential, appeared insufficient to overcome patients' concerns about pain. Therefore, the implement of a systematic screening for arthralgia and the improvement of analgesic treatment are essential issues. New strategies for pharmacological and nonpharmacological treatment must be developed.


Assuntos
Inibidores da Aromatase/uso terapêutico , Artralgia/tratamento farmacológico , Neoplasias da Mama/tratamento farmacológico , Idoso , Ansiedade , Inibidores da Aromatase/administração & dosagem , Estudos Transversais , Depressão , Medo , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Qualidade de Vida , Inquéritos e Questionários
7.
Bull Cancer ; 102(2): 174-81, 2015 Feb.
Artigo em Francês | MEDLINE | ID: mdl-25609484

RESUMO

Communication training programs in oncology have demonstrated some efficacy to improve doctors' communication skills. The goal of our study was to evaluate the impact of such training in the particular context of phase I clinical trials. Self-satisfaction and self-efficacy scales evaluating doctor-patient communication was completed by 6 medical oncologists (3 juniors and 3 seniors) before and after their communication training for a total of sixty visits. Two types of visit have been distinguished: the visits between the oncologist and the patient alone (a dual situation) and those with a third party (a trilateral situation). For all the doctors in dual and trialateral situations, self-efficacy scores improved significantly after training. This improvement was more pronounced for juniors oncologists in trilateral situations. Before training, satisfactory scores were worst in duel versus trilateral situations (P=0.01). This was particularly pronounced for junior compared to senior doctors (P=0.035). After training, in trilateral situations, the satisfaction scores of junior doctors matched that of the senior doctors. The communication training programs appear to benefit junior oncologists to a greater extent in trilateral situations.


Assuntos
Ensaios Clínicos Fase I como Assunto , Comunicação , Acompanhantes Formais em Exames Físicos , Oncologia/educação , Corpo Clínico/psicologia , Relações Médico-Paciente , Autoeficácia , Humanos , Satisfação Pessoal
8.
Rev Prat ; 64(1): 55-6, 59-60, 2014 Jan.
Artigo em Francês | MEDLINE | ID: mdl-24649547

RESUMO

Announcing a diagnosis of cutaneaous melanoma is a complex moment of medical activity and has some specificities due to the disease, but also to its management. After defining these aspects, the article deals with the principals steps and elements, including communicative ones, of this form of announcement. Its aim is above all practice: it is proposing some guidelines drawn from official recommendations and recent works on the physician-patient relationship in oncology, aiming at helping health professionals in this field.


Assuntos
Melanoma/diagnóstico , Melanoma/psicologia , Relações Médico-Paciente , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/psicologia , Revelação da Verdade , Humanos , Autoimagem , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle
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