Abstract
We present a study about the relations between pediatric oncological haematologists, mothers, and children in sharing bad news (BN) in a public hospital in Rio de Janeiro. The text emphasizes the intertwining of technique and emotions for the treatment of children with diagnoses in which the fatal outcome is always a probability. We used a qualitative approach, privileging participant observation and open interviews with oncologists (at this service all professionals were female) and mothers. We sought to understand the importance of communication which includes expressions and control of emotions; bioethical issues that require sensitivity, serenity, and truth about approaching the end of life; and how the professionals balance proximity to children and families and objectivity in their activity. The main results showed: intense exchanges on BN among professionals; relapse of children who were evolving positively as the most difficult news; constant update of BN facing terminally ill children; quality of communication influencing the treatment; professionals permanently balancing between closeness and distance from patients and evidence of the their irreplaceable role to secure the family and the child.
Highlights
This paper presents the results of a survey which sought to understand the management of emotions involved in the relationship between doctors, mothers, and children in sharing the bad news experience (BN) in a haematological pediatric oncology service
The term BN used by the Instituto Nacional de Câncer refers to the communication about the diagnosis, prognosis, or failure of treatment; it is this information that affects adversely and negatively the routine, the future vision and plans for a person[2]
For this study the intertwining of technique and emotion in communicating bad news was considered, which constitutes an inter-subjective act entrained by both medical culture[18,19] as well as by emotions[17] through a comprehensive and critical research preceded by two activities: (1) the Ciência & Saúde Coletiva, 22(1):53-62, 2017 literature on the BN subject that, in turn, fits into the interior of the analysis of relationships between doctors and patients[7,8,9,10,11,20]; (2) and preliminary contacts for three months with the locale and with the team leading the service, in which it was possible to observe important aspects of their relational dynamics and their expressions of emotions
Summary
This paper presents the results of a survey which sought to understand the management of emotions involved in the relationship between doctors, mothers, and children in sharing the bad news experience (BN) in a haematological pediatric oncology service. For this study the intertwining of technique and emotion in communicating bad news was considered, which constitutes an inter-subjective act entrained by both medical culture[18,19] as well as by emotions[17] through a comprehensive and critical research preceded by two activities: (1) the Ciência & Saúde Coletiva, 22(1):53-62, 2017 literature on the BN subject that, in turn, fits into the interior of the analysis of relationships between doctors and patients[7,8,9,10,11,20]; (2) and preliminary contacts for three months with the locale and with the team leading the service, in which it was possible to observe important aspects of their relational dynamics and their expressions of emotions.
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