br opinion to presenting the child with other choices
opinion, to presenting the child with other choices, or to respecting the child’s refusal . Recognition of the child’s right to information, which was observed in the practice of these residents, originates in the French law of March 4, 2002. This Act imposes a duty on the physician to inform the child in a manner appropriate to the child’s maturity, since the child may even ask for medical confidentiality from his/her parents; the act also strengthens the participation of underage patients in decision-making processes affecting them . On the other hand, the lack of information to the child observed in our survey may be due to the limits of the code of medical ethics of the Ivory Coast, which is still based on the model of medical paternalism. Although the United Nations Convention has been ratified, there has been no legal provision for the enforcement of children’s rights in the area of health. The code of ethics currently in force was established by the Act of July 31, 1962 . The ‘‘say or not say in oncology’’ can be influenced by culture. In Africa, the primacy of the Anisomycin over the individual and the attachment to customs and traditions interfere with the principle of autonomy of the individual . Cultures advocating the acquisition of independence and autonomy invite the child to participate in the decision-making process . This is the case in Anglo-Saxon countries where the communication that began a long time ago with the adult is increasingly extended to the child. In most countries with community values like ours, the tendency to ‘‘say’’ is emerging for adults but not for children. Thus, 34% of Japanese physicians never or rarely make announcements to the child compared with less than 1% of American physicians . Some cultures do not recognize the child as being psychologically equipped to deal with devastating news ; unfortunately, there are hardly any data in the literature on this issue as far as the different African cultures are concerned. Children have their own information needs; therefore, the physician and the health-care team must talk to the child and offer different explanations and vocabulary depending on whether they are dealing with a very young child, a school-aged child, or a teenager. The physician must also take into account the child’s own needs according to age, and respect the rhythm, the time, and the desire to be informed or not [3,9]. Our survey revealed the predominant role of parents in informing the child (31.88% of children informed by the father and/or mother). Although many parents question their role in providing information to their child, it is always the responsibil-ity of the physician to make the announcement . For this to happen, parents must adhere to a decision to inform the child, although parents will gladly take the child away to protect him or her; 50.72% of the accompanying persons in our study thought the child should not be informed. However, children may be partly relieved to understand the origin of what they are experiencing and feeling in their bodies , and lungs is also known that informing the child directly allows him/her to better cope with the disease and leads to better compliance with treatment . The insufficient ability of the child reported by the interviewees is an obstacle frequently cited in the literature [27–29]. Certainly, there is a link in this survey between the ability of the child and the child’s age. Age must not be understood in a strict chronological sense but in the sense of ability; it would be appropriate to talk about the level of development. This shortcut used by parents to protect their child facilitates their decision not to inform the child . r> Certain limitations concerning this work should be emphasized. Our survey was based on the analysis of the interview regarding announcements made to parents. A work based on the assessment of physician practices by an informed external observer would provide more reliable information. On the other hand, a survey of physicians is essential to highlight the benefits and difficulties associated with the use of the current guide.
Please cite this article in press as: Couitche´re´ L, et al. Analysis of diagnosis announcements in Abidjan pediatric oncology unit 2 years after introduction of the African Pediatric Cancer Announcement Guideline. Archives de Pe´diatrie (2019), https://doi.org/10.1016/ j.arcped.2019.06.006
Our survey revealed that the majority of parents actually benefited from an interview regarding the announcement that identified the disease and described their child’s treatment plan. However, in some cases, the announcement was made in the presence of a third party. Our survey also identified barriers to the announcement, including medical vocabulary and communication problems. The sick child is not involved in the information process. This work also made it possible to identify several solutions likely to improve the quality of the diagnosis announcement: traceability of the information and the terms used during the announcement, implementation of information media adapted to the child and the families, practical training of physicians in the technique of announcing bad news. The real challenge would be to have a code of medical ethics in conformity with the principle of autonomy and requiring the physician to inform the child.