Health professionals’ perception of distress in cancer patients and family members : measuring accuracy and examining the role of empathic skills
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Mots-clés
- Repérage de la détresse
- Cancer
- Patient-centered care
- Health care professionals
- Empathie
- Prise de perspective
- Soins centrés sur le patient
- Professionnels de la santé
- Parents
- Detection of distress
- Empathy
- Perspective taking
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Résumé
Résumé
Le cancer est une expérience éprouvante pour les personnes touchées par cette maladie, qui doivent s’adapter à une variété de conséquences psychosociales. La gestion de la détresse psychologique chez les patients et chez leurs proches est un aspect fondamental des soins centrés sur la personne. De récentes avancées en recherche et en standards de pratique permettent un repérage plus précis de la détresse. L’administration systématique de tests de dépistage est devenue pratique courante. Cependant, plusieurs avenues intéressantes demeurent inexploitées. Le but principal de cette thèse était d'examiner les habiletés empathiques, notamment la prise de perspective, en tant que stratégies complémentaires pour améliorer le repérage de la détresse.
L’objectif de la première étude était d’examiner la capacité empathique des médecins à repérer la dépression chez les adultes atteints d’un cancer avancé. La recherche existante suggère que les professionnels ont de la difficulté à repérer la détresse de leurs patients avec précision. Nous avons examiné l’accord médecin-patient sur le niveau de dépression des patients, et ce, à l’aide de mesures plus fidèles et plus valides que celles typiquement rapportées dans la littérature. Afin de fournir des renseignements plus détaillés sur la performance des médecins, les analyses ont été réalisées au niveau des symptômes, ainsi qu’au niveau des scores globaux. Des analyses de régression ont servi à examiner la relation entre des variables d’habileté empathique et l’accord médecin-patient. Les résultats suggèrent que les médecins ont de la difficulté à repérer les symptômes dépressifs, particulièrement ceux de nature plus subtile. La capacité auto-rapportée des médecins à faire preuve de compassion, la qualité de leur relation avec le patient et leur sentiment d'auto-efficacité ont prédit un meilleur accord avec les patients sur un ou plusieurs symptôme(s) dépressif(s).
L’objectif de la deuxième étude était de comparer deux types de prise de perspective sur la capacité des soignants à repérer la détresse chez des parents d’enfants atteints d’un cancer. Une étude quasi-expérimentale a été conçue en intégrant des idées théoriques et méthodologies du domaine de la psychologie sociale. Divers professionnels en oncologie ont été aléatoirement répartis en deux groupes. Ils ont visionné une vidéo présentant des parents de patients pédiatriques. Les soignants du groupe imagine-self devaient s’imaginer comment ils se sentiraient et comment leur propre vie serait affectée s’ils se trouvaient dans les situations décrites par les parents. Les soignants du groupe imagine-other devaient s’imaginer comment les parents se sentaient et comment leur vie avait été affectée. En comparant les deux groupes, aucune différence significative n’a été obtenue pour l’accord soignant-parent sur les sentiments et les pensées des parents. Les soignants rapportant s’être mieux concentrés sur leurs propres sentiments, conformément à la perspective imagine-self, avaient tendance à obtenir un plus faible niveau d’accord. Le groupe imagine-self a rapporté significativement plus de détresse que le groupe imagine-other. Aucune association n'a été trouvée entre la détresse du soignant et l'accord soignant-parent.
Les habiletés empathiques pourraient améliorer le repérage de la détresse en oncologie. Ce domaine de recherche a le potentiel d’influencer la formation des professionnels, la gestion des ressources et possiblement la prévention de l'épuisement professionnel. La réalisation d’études expérimentales sera nécessaire à élaboration de recommandations fondées empiriquement.
Dealing with cancer and its treatment is an important life challenge for patients and family members, who must adapt to a variety of psychosocial consequences related to the illness. Managing psychological distress in persons affected by cancer is an important aspect of whole-patient and family-centred care. Recent advances in cancer care research and policy have allowed for more accurate detection of distress. Routine administration of screening tests is now common practice. However, many avenues are left unexploited. The principal aim of the present thesis was to examine empathic skills such as perspective taking as a complementary strategy for improving the detection of distress in adults affected by cancer. The objective of the first study was to examine physicians’ natural empathic ability to detect depression and general distress in adults with advanced cancer. Previous findings suggested that oncology professionals often struggle to accurately detect patient distress. We verified this phenomenon by employing more reliable and valid measures of patient-physician agreement than those most commonly reported in the literature. Analyses of agreement were conducted at both global and symptom levels in an effort to provide more detailed information on physicians’ performance. In addition, regression analyses were performed to examine variables of empathic ability as possible correlates of patient-physician agreement on depressive symptoms. The results suggest that physicians have difficulty detecting depressive symptoms, particularly those that are more subtle in nature. Physicians’ self-reported ability to provide compassionate care, quality of relationship with the patient, and self-efficacy in detecting patient distress, were all associated with higher patient-physician agreement on at least one depressive symptom. The main objective of the second study was to compare two types of perspective taking on clinician ability to detect distress in parents of children with cancer. A quasi-experimental study was designed through the integration of basic theory and methodology from social psychology research. Oncology professionals were randomly assigned to one of two groups, and were then shown a video featuring parents of children with cancer. In the imagine-self group, they were instructed to imagine the feelings and life consequences which they would experience if they were in each parent’s situation. In the imagine-other group, they were instructed to imagine the feelings and life consequences experienced by the parents. No significant group differences were found for parent-clinician agreement on parents’ negative thoughts and feelings. However, clinicians who, in accordance with the imagine-self perspective, reported being more concentrated on their own feelings tended to show lower agreement. Clinicians who were instructed to adopt an imagine-self perspective reported significantly more distress than those instructed to adopt an imagine-other perspective. No association was found between clinician distress and parent-clinician agreement. The findings of this thesis suggest that empathic skills could significantly contribute to accurate detection of distress in persons affected by cancer. This new line of research could have important implications for communication training, management of psychosocial resources, and possibly prevention professional burnout. More experimental research is needed before evidence-based guidelines can be elaborated.
Dealing with cancer and its treatment is an important life challenge for patients and family members, who must adapt to a variety of psychosocial consequences related to the illness. Managing psychological distress in persons affected by cancer is an important aspect of whole-patient and family-centred care. Recent advances in cancer care research and policy have allowed for more accurate detection of distress. Routine administration of screening tests is now common practice. However, many avenues are left unexploited. The principal aim of the present thesis was to examine empathic skills such as perspective taking as a complementary strategy for improving the detection of distress in adults affected by cancer. The objective of the first study was to examine physicians’ natural empathic ability to detect depression and general distress in adults with advanced cancer. Previous findings suggested that oncology professionals often struggle to accurately detect patient distress. We verified this phenomenon by employing more reliable and valid measures of patient-physician agreement than those most commonly reported in the literature. Analyses of agreement were conducted at both global and symptom levels in an effort to provide more detailed information on physicians’ performance. In addition, regression analyses were performed to examine variables of empathic ability as possible correlates of patient-physician agreement on depressive symptoms. The results suggest that physicians have difficulty detecting depressive symptoms, particularly those that are more subtle in nature. Physicians’ self-reported ability to provide compassionate care, quality of relationship with the patient, and self-efficacy in detecting patient distress, were all associated with higher patient-physician agreement on at least one depressive symptom. The main objective of the second study was to compare two types of perspective taking on clinician ability to detect distress in parents of children with cancer. A quasi-experimental study was designed through the integration of basic theory and methodology from social psychology research. Oncology professionals were randomly assigned to one of two groups, and were then shown a video featuring parents of children with cancer. In the imagine-self group, they were instructed to imagine the feelings and life consequences which they would experience if they were in each parent’s situation. In the imagine-other group, they were instructed to imagine the feelings and life consequences experienced by the parents. No significant group differences were found for parent-clinician agreement on parents’ negative thoughts and feelings. However, clinicians who, in accordance with the imagine-self perspective, reported being more concentrated on their own feelings tended to show lower agreement. Clinicians who were instructed to adopt an imagine-self perspective reported significantly more distress than those instructed to adopt an imagine-other perspective. No association was found between clinician distress and parent-clinician agreement. The findings of this thesis suggest that empathic skills could significantly contribute to accurate detection of distress in persons affected by cancer. This new line of research could have important implications for communication training, management of psychosocial resources, and possibly prevention professional burnout. More experimental research is needed before evidence-based guidelines can be elaborated.
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