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Haaser T, Lahmi L, Osman D, Gesbert C, Cheval V, Constantinides Y, de Crevoisier R, Dejean C, Escande A, Ghannam Y, Lorchel F, Thureau S, Lagrange JL, Durdux C, Huguet F. [Ethical stakes of information in radiation oncology: Thinking the risk and building the therapeutic alliance]. Cancer Radiother 2023; 27:480-486. [PMID: 37573195 DOI: 10.1016/j.canrad.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 08/14/2023]
Abstract
Informing patients before receiving radiation therapy is a fundamental ethical imperative. As a condition of the possibility of autonomy, information allows people to make health decisions concerning themselves, which is required by French law. This information includes in particular the potential risks due to radiation therapy. It is therefore necessary to think about what risk is, and how to define and assess it, in order to finally communicate it. The practice of informing people involves many ethical issues relating to the very content of the information, the form in which it is transmitted or even the intention that leads the health professional to say (or not to say) the risk. The transmission of information also questions the way to build a relationship of trust with the patients and how to integrate their own representations about these treatments. Between the risks of paternalism or even defensive medicine, this practice is at the heart of our professional practice.
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Affiliation(s)
- T Haaser
- Service d'oncologie radiothérapie, hôpital Haut Lévêque, centre hospitalier universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France; Centre éthique et recherche en santé de Bordeaux, centre hospitalier universitaire de Bordeaux, Bordeaux, France; EA 4574 sciences, philosophie, humanités, universités de Bordeaux et Bordeaux Montaigne, Pessac, France.
| | - L Lahmi
- Service d'oncologie radiothérapie, institut Curie, Paris, France
| | - D Osman
- Service de médecine intensive-réanimation, hôpital de Bicêtre, AP-HP, DMU Correve, université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France
| | - C Gesbert
- Direction de la qualité, des services aux patients et des parcours, centre hospitalier de Versailles, Versailles, France
| | - V Cheval
- Service universitaire d'oncologie radiothérapie, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, laboratoire CRIStAL, UMR9189, université de Lille, Lille, France
| | - Y Constantinides
- Espace éthique Île-de-France, Paris université Sorbonne Nouvelle, Paris, France
| | - R de Crevoisier
- Service d'oncologie radiothérapie, centre Eugène-Marquis, Rennes, France
| | - C Dejean
- Service d'oncologie radiothérapie, unité de physique médicale, centre Antoine-Lacassagne, Nice, France
| | - A Escande
- Service universitaire d'oncologie radiothérapie, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, laboratoire CRIStAL, UMR9189, université de Lille, Lille, France
| | - Y Ghannam
- Service d'oncologie radiothérapie, hôpital Tenon, centre de recherche Saint-Antoine UMR_S 938, institut universitaire de cancérologie, AP-HP, Sorbonne université, Paris, France
| | - F Lorchel
- Service d'oncologie radiothérapie, centre hospitalier universitaire Lyon-Sud, Lyon, France; Centre d'oncologie radiothérapie et oncologie de Mâcon (Orlam), Mâcon, France
| | - S Thureau
- Service d'oncologie radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - J L Lagrange
- Université Paris-Est Créteil Val-de-Marne, Paris, France
| | - C Durdux
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, centre de recherche Saint-Antoine UMR_S 938, institut universitaire de cancérologie, AP-HP, Sorbonne université, Paris, France
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de Crevoisier R, Leseur J, Bouvet C, Huguet F, Lagrange JL, Haaser T, Pasquier D, Créhange G, Supiot S, Pommier P, Roy A, Berna A, Blanchard P, Marcucci L. Compréhension/acceptation de la radiothérapie : un dilemme éthique résolu par une éthique de la considération et de la sollicitude. Cancer Radiother 2023; 27:115-125. [PMID: 37011968 DOI: 10.1016/j.canrad.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 03/02/2023]
Abstract
PURPOSE Ethical questions are poorly investigated specifically in radiation oncology. The objective of the study was to identify and understand the main ethical issue in radiation oncology. MATERIALS AND METHODS A quantitative analysis was based on the answers to a questionnaire of 200 professionals from 22 radiation oncology departments. The questionnaire mainly aimed to characterize the main ethical issue. A monocentric qualitative analysis was based on semi-structured interviews focused on the main identified ethical issue, carried out with eight technologists, and 20 patients undergoing radiotherapy. RESULTS The main ethical issue was the understanding and/or acceptance of the treatment by the patients (71 %), which frequently arises (more than once a month) (52 %), and corresponds to an ethical tension between the principles of respect for autonomy and beneficence (the good as viewed by the patient) as defined by Beauchamp and Childress. The technologists, wish the patient to be fully involved in his treatment, with the even possibility of refusing it. However, excluding paternalism and autonomic relentlessness, the technologists have the feeling of acting for the good of the patients by treating them with radiation, even if the patients are not always aware of it, because they are within a situation of vulnerability. If the hierarchy of principles is a compromise alternative, this problem is finally well resolved by the effective implementation of an ethic of consideration and solicitude, restoring the patient capabilities, i.e. the maximum development of his potentialities in his situation of vulnerability. Beyond the legal dimension, patient information is crucial and must consider the specific temporality of the patient. CONCLUSION The main ethical issue in radiation oncology is the understanding and/or acceptance of the treatment involving the development of an ethic of consideration and solicitude.
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Haaser T, Constantinides Y, Huguet F, De Crevoisier R, Dejean C, Escande A, Ghannam Y, Lahmi L, Le Tallec P, Lecouillard I, Lorchel F, Thureau S, Lagrange JL. [Ethical stakes in palliative care in radiation oncology]. Cancer Radiother 2021; 25:699-706. [PMID: 34400087 DOI: 10.1016/j.canrad.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
In 2021, the Ethics Commission of the SFRO has chosen the issue of the practice of palliative care in radiotherapy oncology. Radiation oncology plays a central role in the care of patients with cancer in palliative phase. But behind the broad name of palliative radiotherapy, we actually find a large variety of situations involving diverse ethical issues. Radiation oncologists have the delicate task to take into account multiple factors throughout a complex decision-making process. While the question of the therapeutic indication and the technical choice allowing it to be implemented remains central, reflection cannot be limited to these decision-making and technical aspects alone. It is also a question of being able to create the conditions for a singularity focused care and to build an authentic care relationship, beyond technicity. It is through this daily ethical work, in close collaboration with patients, and under essential conditions of multidisciplinarity and multiprofessionalism, that our fundamental role as caregiver can be deployed.
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Affiliation(s)
- T Haaser
- Service d'Oncologie Radiothérapie, Hôpital Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France.
| | - Y Constantinides
- Espace Éthique Ile de France, Paris Université Sorbonne Nouvelle, Paris, France
| | - F Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - R De Crevoisier
- Service d'Oncologie Radiothérapie, Centre Eugène Marquis, Rennes, France
| | - C Dejean
- Service d'Oncologie Radiothérapie, Unité de Physique Médicale, Centre Antoine Lacassagne, Nice, France
| | - A Escande
- Service universitaire d'Oncologie Radiothérapie, Centre Oscar Lambret, Faculté de médecine Henri Warembourg, Laboratoire CRIStAL, UMR9189, Université de Lille, Lille, France
| | - Y Ghannam
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - L Lahmi
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - P Le Tallec
- Service d'Oncologie Radiothérapie, Quantis Litis EA 4108, Centre Henri Becquerel, Rouen, France
| | - I Lecouillard
- Service d'Oncologie Radiothérapie, Centre Eugène Marquis, Rennes, France
| | - F Lorchel
- Service d'Oncologie Radiothérapie, Centre Hospitalier Universitaire Lyon-Sud, Lyon, France; Centre d'Oncologie Radiothérapie et Oncologie de Mâcon - ORLAM, Mâcon, France
| | - S Thureau
- Service d'Oncologie Radiothérapie, Quantis Litis EA 4108, Centre Henri Becquerel, Rouen, France
| | - J L Lagrange
- Université Paris-Est Créteil Val de Marne, Paris, France
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Haaser T, Constantinidès Y, Dejean C, Escande A, Le Tallec P, Lorchel F, Marty S, Thureau S, Huguet F, Lagrange JL. [Health democracy: Patient partnership]. Cancer Radiother 2020; 24:736-743. [PMID: 32861610 DOI: 10.1016/j.canrad.2020.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/20/2022]
Abstract
In 2019, the scientific committee of the French society of radiation oncology (SFRO) created an ethics committee. Its mission is to provide our professional community with food for thought on ethical issues, and to identify its specificities within the radiation oncology departments. For the 2020 annual conference, the commission looked into the evolution of the patient-carer relationship, and more particularly to the strong idea of patient partnership. Indeed, the writing of the White Book of Cancer gave voice to sick people and stressed the need for new devices, such as the Caregiving Time. Patients can no longer be considered as objects of care but as people whose dignity and autonomy must be imperatively respected. The acquisition of knowledge allows a bilateral exchange, prerequisite of a dynamic collaboration. Patients can be partners in their own care, partners in training and research (expert patient), but also partners in health institutions and policies. It is this notion of partnership and involvement of the person in their path of care in radiation oncology that we will analyse here. It will be about defining it, by developing the concept of autonomy, and bringing out its complexity and ambivalence through two examples from our clinical practice: the shared decision-making process for patients with localized prostate cancer and the patient's involvement in the success of his radiotherapy.
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Affiliation(s)
- T Haaser
- Service de radiothérapie, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, Pessac, France.
| | - Y Constantinidès
- Espace éthique Île-de-France, Paris Université Sorbonne Nouvelle, Paris, France
| | - C Dejean
- Service de radiothérapie, unité de physique médicale, centre Antoine-Lacassagne, Nice, France
| | - A Escande
- Service universitaire de radiothérapie, laboratoire CRIStAL, UMR9189, centre Oscar-Lambret, faculté de médecine Henri-Warembourg, université de Lille, Lille, France
| | - P Le Tallec
- Service de radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - F Lorchel
- Centre de radiothérapie et oncologie de Mâcon - Orlam, Mâcon, France; Service de radiothérapie, centre hospitalier universitaire Lyon-Sud, Lyon, France
| | - S Marty
- Centre de coordination en cancérologie, centre hospitalier universitaire de Bordeaux, Pessac, France
| | - S Thureau
- Service de radiothérapie, Quantis Litis EA 4108, centre Henri-Becquerel, Rouen, France
| | - F Huguet
- Service d'oncologie radiothérapie, centre de recherche Saint-Antoine UMR_S 938, Sorbonne université, hôpital Tenon, institut universitaire de cancérologie, AP-HP, Paris, France
| | - J-L Lagrange
- Université Paris-Est Créteil Val-de-Marne, Paris, France
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