The place of the relative at the time of the announcement of cancer progression. BABEL, a mixed-method study

Abstract Background Few studies have evaluated the place of cancer patient’s relatives during a consultation bringing bad news. Aim To explore how a relative’s presence in these consultations helps communication. Design : Oncologist consultations with patients and relatives for the announcement of cancer progression were recorded, then the different participants completed questionnaires. Answers were further investigated in a few semi-structured interviews. Comparison of quantitative responses (questionnaires) used Wilcoxon's test for matched series. Qualitative analysis (consultations, interviews) used grounded theory. Results were interpreted in a mixed-method integrative approach. This study received the regulatory authorizations. Setting/participants : Patients were aged over 18, followed for cancer in palliative phase, excluding brain tumors and malignant haemopathies, presented renewed disease progression. Relatives were aged over 18 and authorized by the patient to participate. Results 47 documented consultations and 12 interviews (4 triads) were collected. For 93% of patients, the presence of a relative was considered beneficial. Half the relatives, while remaining discreet, nevertheless contributed to the discussion. Although their relationship to time and their expectations may differ, patients and relatives found the consultation positive. However, oncologists did not check what the dyad had retained. They appeared to underestimate the patient's level of understanding (P<0.001) and perceptions of the seriousness of the disease (P=0.009) but not those of relatives. They did not evaluate the relative's state of health. Conclusion Availability of oncologists to patients and families could be improved. Training via simulation sessions should be adapted to communication implying relative.