Epidemiology of burn in Franche-Comté: Activity of the emergency mobile medical service of the hospital of Besançon from 2002 to 2008

Abstract

Étudier la perception qu'ont les parents des avantages et des inconvénients d'un hôpital de jour en oncologie pédiatrique afin de mieux adapter celui-ci aux besoins de l'enfant et à leurs attentes, et de mieux développer les alternatives à l'hospitalisation conventionnelle.Pendant 15 jours, 39 parents d'enfants traités en hôpital de jour ont reçu un questionnaire sur leur perception comparée de l'hôpital de jour et de l'hospitalisation conventionnelle.De façon significative, les parents sont plus nombreux à préférer l'hôpital de jour à l'hospitalisation conventionnelle (69% contre 15%). La maladie y semble moins grave, l'hôpital de jour apparaît mieux adapté à l'enfant, préserve mieux leur vie de famille mais pas leurs activités sociales et professionnelles. En revanche, l'hospitalisation conventionnelle fournit une information meilleure, et surtout permet une meilleure intégration de l'enfant et des parents dans le département, et de meilleures relations aux autres parents. Habiter loin de l'hôpital, un manque de ponctualité et d'informations, la peur d'avoir à assumer trop de responsabilité peuvent annuler les avantages de l'hôpital de jour.Les parents apprécient les objectifs de l'hôpital de jour (limiter les contraintes des traitements pour l'enfant et sa famille, préserver la qualité de leur vie familiale, sociale, professionnelle, préserver la sécurité des traitements, en diminuer le coût). Mais l'existence seule de l'hôpital de jour ne suffit pas. L'hôpital de jour doit tenir compte des caractéristiques matérielles, sociales, économiques et psychologiques des parents et des familles, de leurs attentes, et disposer de moyens suffisants en matériel et en personnel. Faute de quoi l'hôpital de jour et les alternatives à l'hospitalisation conventionnelle risquent de ne pas répondre aux attentes des familles, voire de produire sur elles des effets négatifs.The aim of this study was to assess parental opinions on the advantages and disadvantages of a pediatric oncology day hospital (DH) so that the structure can be better adapted to the children's needs and parents' expectations, and provide a potentially valid alternative to conventional hospitalization (CH).Over a 15-day period, 39 parents of children treated at a DH were approached and asked to fill in a questionnaire on their opinion of the advantages and disadvantages of a DH compared to a CH.The results of this survey were significant. The majority of parents preferred the DH to the CH (69% versus 15%). The illness was perceived as being less severe; and as the child was not continually in the CH context, he/she was able to forget the illness and the hospital to some extent, and was therefore not as anxious. The DH appeared to be better adapted to the child's needs and facilitated the pursuit of normal family life and everyday activities, but imposed constraints on social and professional activities. On the other hand, the CH provided a reassuring treatment context including more comprehensive information, and in particular a better integration of the child and careful monitoring of the disease within the oncology department, and closer relations between the different parents visiting the hospital. In spite of the high preference rate for the DH, in some instances certain disadvantages could outweigh the advantages, e.g., fatigue due to journeys to and from the hospital, or living too far away from the DH; a lack of punctuality, which meant that the parents were unable to plan their day with any certainty; insufficient comfort (noise, a limited number of rooms available); inadequate information; a lack of privacy; and the anxiety connected with having to assume too much responsibility.Overall, it was concluded that the parents appeared to appreciate the aims of the DH (i.e., limiting the treatment constraints imposed on the patient and on the parents themselves, thereby maintaining the quality of family life, assuring adequate treatment, reducing cost of treatment). However, the authors consider that the DH has to be organized in such a way that it takes into account the following: the social aspects, i.e., living conditions, parents' social, economic and professional status; parents' and children's psychological traits, expectations; and access to a local care system. The DH should also have sufficient means and staff at its disposal. Without taking these factors into consideration, the DH and other alternatives to the CH will not be able to adequately care for the patients, or meet the parents' expectations, and may even have a negative effect on the family.