Haaser Thibaud, Constantinides Yannis, Osman David, Lahmi Lucien, Durdux Catherine, Bourbonne Vincent, Cheval Véronique, de Crevoisier Renaud, Dejean Catherine, Ducteil Angélique, Escande Alexandre, Gesbert Cédric, Ghannam Youssef, Lemanski Claire, Thureau Sébastien, Lagrange Jean-Léon, Huguet Florence
Service d'oncologie radiothérapie, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, 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.
Espace éthique Île-de-France, Paris université Sorbonne Nouvelle, Paris 4, Paris, France.
Cancer Radiother. 2024 Nov;28(6-7):527-533. doi: 10.1016/j.canrad.2024.07.017. Epub 2024 Oct 5.
The term "event" covers a wide range of concrete situations in radiation oncology, from particularly intense radiation-related side effects to the possibility of technical or human error. Although quality procedures are an integral part of radiotherapy oncology department operations ensuring the analysis and prevention of such events, their occurrence during radiation treatment still has a significant impact on patients and their experience of the treatment process, as well as on health professionals. These practical, emotional and symbolic impacts are all the greater when the event occurs in the aftermath of an error. The ethical approach therefore comprises three essential stages: recognizing the event as such, informing those involved of the event and, finally, creating conditions for the continuation of care. Each of these stages is marked by specific issues and questions, requiring a complex ethical approach that constantly involves reconciling the possible divergent perceptions of patients and health professionals. The occurrence of an event can also lead to a genuine crisis of confidence with multiple dimensions, which health professionals will also have to face and to support. Finally, the occurrence of an event calls into question not only our responsibility towards patients, but also our ideal of control. We need to criticize our culture of performance, rethink our approach to events and errors, and see them also as opportunities for positive change.
“事件”一词涵盖了放射肿瘤学中广泛的具体情况，从特别严重的辐射相关副作用到技术或人为错误的可能性。尽管质量程序是放射肿瘤学部门运作中不可或缺的一部分，可确保对此类事件进行分析和预防，但这些事件在放射治疗期间的发生，仍然会对患者及其治疗过程体验以及医疗专业人员产生重大影响。当事件发生在错误之后时，这些实际、情感和象征性的影响就会更大。因此，伦理方法包括三个基本阶段：确认该事件本身、将该事件告知相关人员，最后，为继续护理创造条件。每个阶段都有特定的问题，需要采用复杂的伦理方法，不断协调患者和医疗专业人员可能存在的不同看法。事件的发生还可能引发多层面的真正信任危机，医疗专业人员也必须面对并应对这种危机。最后，事件的发生不仅使我们对患者的责任受到质疑，也使我们的控制理想受到质疑。我们需要批判我们的绩效文化，重新思考我们处理事件和错误的方式，并将它们视为积极变革的机会。
