Shock, anger, sadness… It’s not easy to learn that you have breast cancer. On the occasion of Pink October, doctors Noémie Lotersztajn (gynecologist specializing in oncology) and Sophie Béranger (radiologist) return to the challenges of the announcement consultation.
The reactions also depend on what the patients have heard before, especially at the level of radiology. If they expect the doctor to say the word cancer, they are less shocked, we can focus the interview on support and positive information. In breast cancer, breast cancer survival is 90%, so that generally softens the initial shock. Afterwards, there are plenty of possible patient profiles, so multiple reactions to the announcement of breast cancer. Do you advise them to come alone or accompanied? Dr Noémie Lotersztajn – We advise women to come rather accompanied, to be able to better absorb the shock, and to have someone at home who can repeat the information to them. During an announcement consultation, the patient retains only 10% of the information given by the doctor, because she focuses on the word “Cancer”. What should be the first reflexes of a sick woman after an announcement consultation? Dr Noémie Lotersztajn – When leaving the consultation, the patients will ask themselves a lot of questions. I advise them to write them down, so that they can send them to the nurse or the doctor during the next interview. How do you best tell a woman she has breast cancer? Dr Noémie Lotersztajn – In ad consultation, the word “Cancer” must be pronounced. Afterwards, you have to use simple words, listen to the patient, let her talk, let her ask questions and, in general, take the time to do the consultation. Once the patient has finished talking, we can start giving information. The interview should not be guided only by the doctor, but also by the patient. Dr Sophie Beranger – At the level of radiology, everything depends on the degree of suspicion. If it is weak, we do not pronounce the word cancer, we let the patient ask questions, and we answer her without lying. If the risk of breast cancer is high, we will explain to her before the announcement consultation that the X-ray is suspicious, to begin to prepare the patient. Afterwards, you have to adapt to each woman: if you see that she doesn’t want to hear the word “Cancer”, we don’t hammer her, we wait until she is ready to receive the information. Has there been any progress on the announcement consultation? Dr Noémie Lotersztajn – There has been great progress following the cancer plan implemented in 2006, which set a framework. Before that, everything was done heterogeneously. There are now several steps that are necessary and mandatory in an announcement consultation, including the paramedic announcement time, which allows the information to be repeated and to check with the patient that she has understood the situation. Are there still things to improve? Dr Noémie Lotersztajn – There is still progress to be made in the training of health professionals. Personally, the announcement consultation was not part of my course, and I would have liked to be able to benefit from feedback for a few hours, in particular to know how to adapt to each patient. Is the announcement consultation a difficult exercise for a doctor?
Dr. Noemie Lotersztajn – Yes always.
Dr Sophie Beranger – It’s a complicated exercise, which you never get used to.
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