Quelle place pour l'enfant dans la prise de décision en pédiatrie ?

doi:10.1016/j.arcped.2005.02.009

Archives de Pédiatrie

Volume 12, Issue 7, July 2005, Pages 1068-1074

https://doi.org/10.1016/j.arcped.2005.02.009 Get rights and content

Résumé

Objectif. – Décrire les pratiques des internes en pédiatrie concernant l'implication de l'enfant dans la décision médicale et évaluer les relations entre ces pratiques et les caractéristiques des internes (âge, sexe, expérience…).

Patients et méthodes. – Étude multicentrique transversale anonyme réalisée auprès de 45 internes en pédiatrie. L'autoévaluation de leur pratique par les internes a été recueillie par l'intermédiaire d'un questionnaire écrit.

Résultats. – Quatre-vingt-deux pour cent des internes en pédiatrie informaient l'enfant, mais le partenariat avec l'enfant diminuait lorsqu'il s'agissait de lui demander son avis, de lui présenter d'autres choix ou de respecter son refus. Les obstacles principaux au partenariat avec l'enfant étaient : le manque de compétence de l'enfant et la situation médicale présente. Aucune relation statistiquement significative n'a pu être mise en évidence entre les pratiques des internes et leurs caractéristiques.

Conclusion. – Le partenariat avec l'enfant lors de prise de décision médicale en pédiatrie varie selon les internes et en fonction du degré d'implication demandé. L'éducation pourrait permettre d'augmenter la participation de l'enfant.

Abstract

Objective. – To describe how paediatric residents involve children during medical decision-making and evaluate the relationship between practice patterns and residents characteristics.

Population and methods. – We conducted a prospective multicentric anonymous written survey. Self-reported involvement of children by 45 french paediatric residents in practice pattern was collected and analysed.

Results. – Most residents reported they informed patients in more than 50% of the cases (82%). Only a minority of the residents asked for consent, respected children refusal or presented other choices to the treatment. The main reasons that explain the lack of partnership are children incompetence and the medical situation. No statistically significant relationship between practice patterns and residents characteristics was found.

Conclusions. – Partnership with children varies across residents and according to the level of involvement considered. No statistical differences were obtained to explain variations between residents'attitude toward involvement of children. Nevertheless medical education in ethics or decision-making could increase partnership with children.

Section snippets

Patients et méthodes

Cette enquête a été menée du mois de mars au mois d'août 2003 auprès des internes en pédiatrie des trois facultés de médecine de Marseille, Nice et Montpellier. Le questionnaire comprenait quatre questions. Les trois premières correspondaient aux trois degrés d'implications croissantes de l'enfant dans la décision médicale [13] : l'information, le recueil de l'avis de l'enfant, le respect de sa décision et donc de son refus éventuel. Nous y avons ajouté une quatrième question dans laquelle nous

Information du patient

Quatre-vingt-six pour cent des internes ont indiqué qu'ils informaient l'enfant dont ils avaient la charge dans plus de la moitié des cas. Pour 53 % d'entre eux, l'information était presque toujours dispensée. À l'inverse, 14 % avouaient n'informer l'enfant que dans moins de la moitié des cas.

Les deux obstacles à l'information de l'enfant les plus fréquemment cités étaient les compétences insuffisantes de l'enfant et les caractères d'urgence ou de dangerosité du problème médical. Le troisième

Discussion

Notre étude montre que les internes en pédiatrie impliquent l'enfant dans la décision médicale (plus de 80 % des internes informent l'enfant dans plus de la moitié des cas) et que le partenariat avec l'enfant diminue de façon nette lorsqu'il s'agit de lui demander son avis et le prendre en compte ou lui présenter d'autres choix.

Cette dissociation a déjà été observée lors d'une étude examinant l'implication d'une vingtaine d'enfants hospitalisés et de leurs parents lors de soins [30] et de

Conclusion

Notre étude montre qu'une grande majorité des pédiatres en formation informe l'enfant sur les choix médicaux le concernant. Néanmoins, quand il s'agit d'associer d'avantage l'enfant dans la décision, la part des internes qui impliquent l'enfant diminue de façon spectaculaire : s'il a droit à l'information, l'enfant n'est donc pas encore considéré comme un réel partenaire avec lequel la décision peut être partagée. Ce phénomène est lié principalement à la complexité de l'évaluation des

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Cited by (9)

Analysis of diagnosis announcements in Abidjan pediatric oncology unit 2 years after introduction of the African Pediatric Cancer Announcement Guideline
2019, Archives de Pediatrie
Citation Excerpt :
Everything is focused on the recognition of the place of the child in receiving information and participating in the decision-making process [20]. However, the child's right to know must take into account the complexity of the situations encountered, as well as the specificities and needs of each child, according to their age, development, and history [4,20]. Our survey showed that very few children were able to benefit from a diagnostic announcement (2 cases, i.e., 2.89%), and no child participated in the decision-making process.
Announcing the diagnosis allows the therapeutic alliance between physicians and patients to be sealed and it prevents abandonment of treatment. To compensate for the deficit in information received by the families, the Franco-African Group of Pediatric Oncology (FAGPO) has published an “African Pediatric Cancer Announcement Guide” for the group's pediatric oncology units.
To analyze the announcements made to parents and children 2 years after the provision of this guide.
Cross-sectional survey conducted from March to July 2016. In total, 69 parents of children followed up in the pediatric oncology unit of Abidjan were interviewed regarding the characteristics of the announcement that was made to them and the information given to the sick child.
Of all the accompanying individuals, 91% reported having benefited from the announcement made with empathy, mainly by a physician. In approximately one quarter of the cases the information had been given to a third party. The main barriers to information were: the negative experiences of parents, the medical terminology, and communication problems. The sick child was rarely informed.
The information given was in accordance, in content and form, with the data from Western and African literature. The lack of information given to the child has a dual explanation: the primacy of the community over the individual advocated by African culture and the non-integration of the rights of children in the current code of ethics.
The information provided could be improved by practical training of physicians in the technique of breaking bad news to patients and their families and the use of a code of ethics in accordance with the principle of autonomy.
Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review of health professionals' perceptions
2008, Patient Education and Counseling
To update a systematic review on the barriers and facilitators to implementing shared decision-making in clinical practice as perceived by health professionals.
From March to December 2006, PubMed, Embase, CINHAL, PsycINFO, and Dissertation Abstracts were searched. Studies were included if they reported on health professionals’ perceived barriers and facilitators to implementing shared decision-making in practice. Quality of the included studies was assessed. Content analysis was performed with a pre-established taxonomy.
Out of 1130 titles, 10 new eligible studies were identified for a total of 38 included studies compared to 28 in the previous version. The vast majority of participants (n = 3231) were physicians (89%). The three most often reported barriers were: time constraints (22/38) and lack of applicability due to patient characteristics (18/38) and the clinical situation (16/38). The three most often reported facilitators were: provider motivation (23/38) and positive impact on the clinical process (16/38) and patient outcomes (16/38).
This systematic review update confirms the results of the original review.
Interventions to foster implementation of shared decision-making in clinical practice will need to address a range of factors.
Barriers and facilitators of pediatric shared decision-making: A systematic review
2019, Implementation Science
Parental decision making involvement and decisional conflict: A descriptive study
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Adolescents, neuroscience and medical decision-making: Should we review certain provisions of the Civil Code of Quebec?
2016, BioethiqueOnline
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Mémoire originalQuelle place pour l'enfant dans la prise de décision en pédiatrie ?How paediatric residents involve children during medical decision-making?

Résumé

Abstract

Section snippets

Patients et méthodes

Information du patient

Discussion

Conclusion

Arch. Pediatr.

Lancet Oncol.

Arch. Pediatr.

Sci. Med.

Lancet Oncol.

Arch. Pediatr.

J. Pediatr.

J. Pediatr.

Arch. Pediatr.

Arch. Pediatr.

Arch. Pediatr.

Du raisonnement médical à la décision partagée

Making decisions with children. Asking children to participate in decisions about their core undermines parents’ position

BMJ

The undereducated physician’s therapeutic decisions

N. Engl. J. Med.

Clinical decisions: from art to science and back again

Lancet

What do we mean by partnership in making decisions about treatment?

BMJ

Informed consent, parental permission, and assent in pediatric practice. Committee on Bioethics, American Academy of Pediatrics

Pediatrics

Hearing children’ voices

Bioethics Forum

A new understanding of consent in pediatric practice: consent, parental permission, and child assent

Pediatr. Ann.

Health care treatment decision-making guidelines for minors

Bioethics Forum

Mémoire original
Quelle place pour l'enfant dans la prise de décision en pédiatrie ?How paediatric residents involve children during medical decision-making?