L’incertitude ou l’espoir ultime. Analyse phénoménologique interprétative du discours de douze soignantes en hématologie

Abstract

ContextThis article is based on Yasmine Chemrouk's doctoral research. It focuses on uncertainty in a hematology department and the subjective experiences of healthcare professionals (HPs) caring for patients with acute leukemia. AimsThere is little prognostic certainty these treatment programs, which frequently involve therapeutic innovations. Understanding how the HPs move from hope to disillusion is necessary in defusing conflicts with the doctors. In addition, this shift from hope to disillusion is accompanied by a loss of meaning in their function. HPs have to endorse the medical decision in order to maintain hope, promoting the patient's adherence to his treatment. Encouraging HPs’ support of medical decisions helps patients maintain hope, which can, in turn, promote their adherence to their treatment plans. MethodA total of 12 HPs in a Hematology Intensive Care Unit participated in our study. Our sampled is composed exclusively of women: six nurses and six nurses’ aides. Interpretative Phenomenological Analysis seemed to be the most appropriate method for studying the subjective experience of HPs dealing with uncertainty. ResultsUncertainty is associated with prognosis. For some, the uncertainty of the prognosis leads to thoughts about failure. For others, the uncertainty of the positive effects of treatment leads to denial and an avoidance of the question of prognosis. Uncertainty is also linked to the unexpected, which unseats an ideal, composed of certainties and false beliefs. Finally, uncertainty can be understood as an opposition to two types of certainty: that of medical knowledge or that of death. The HPs spoke also about the necessity of hope, which seems to allow them to continue to find meaning in their work. In addition, uncertainty is understood as the impossibility to determine the lethality of the disease; certainty, in this case, is linked to death. Furthermore, hope can promote the HPs’ adherence to patient's treatment. Consent to treatment is necessary, in light of the side effects of many treatments; it also allows HPs to bear their patients’ suffering. Finally, for the HPs, ignorance and credulity can replace the couple certainty-uncertainty, allowing them to exist in a more comfortable and less dramatic place. ConclusionThere is a kind of all-or-nothing divide, which reminds us of the feeling that the caregivers evoke in their perception of medical care. During the first treatment, hope is present, and then if the treatments are ineffective, hope dissipates and is replaced by a feeling of therapeutic obstinacy. Group sessions should be set up to enable caregivers to identify the counter-transferential issues necessary to maintain the therapeutic relationship. Psychotherapy based on mentalization also offers interesting perspectives. HPs’ lack of knowledge of treatments certainly contributes to the extent of their fantasies. Moreover, these fantasies are not shared by doctors, who have deeper knowledge about the treatments they prescribe.