O presente trabalho construiu-se a partir dos novos paradigmas que permeiam a relação médico-paciente. Se o profissional não mais se encontra em uma posição de superioridade (ao menos do ponto de vista fático) em face de seu paciente, que por sua vez está mais sensível em virtude das transformações oriundas da sociedade de massa, o elemento informação ganhou contornos importantíssimos, inserindo-se no núcleo principal da prestação, ao lado dos cuidados relativos à saúde propriamente ditos. Nesse contexto, foi proposta uma nova visão do dever de informar na relação médico-paciente, tratando a informação como uma obrigação autônoma, que gera de per se em caso de ausência ou vício responsabilização civil. A reparação, em tal perspectiva, surge a partir da violação do direito à liberdade: se a autodeterminação é um atributo da personalidade do paciente, a afronta a esse direito acarreta danos indenizáveis. Os limites do dever de informar, assim, desempenham relevante papel, pois demarcam a tênue linha que distingue a informação viciada (que ensejará responsabilização civil) daquela transmitida diligentemente. Assim, o conteúdo e a extensão da informação foram abordados, confrontando-se aspectos subjetivos, objetivos e buscando uma solução ao mesmo tempo viável (do ponto de vista prático), jurídica e justa. Como o trabalho trata essencialmente do dever de informar na relação médico-paciente e das consequências jurídicas derivadas do inadimplemento dessa obrigação, foram destrinchados todos os elementos que compõem esse complexo vínculo, passando por sua evolução histórica, pelos princípios, valores e direitos que permeiam e iluminam esta relação e, finalmente, pelos sujeitos que a compõem. Aspectos processuais atinentes à prova do cumprimento do dever de informação foram, ainda, examinados. Diversas questões polêmicas, tais como recusa de tratamento, direito a não saber, privilégio terapêutico, dentre outros, foram também debatidos. / This study is based on the new paradigms that permeate the doctor-patient relationship. If the medical professional no longer holds a superior position (at least from the factual point of view) vis a vis the patient who, on the other hand, is more aware to changes originating from doctor-patient relationship in the mass society, information availability has gained highly important contours, inserting itself into the core of services rendered, together with health care services themselves. In this context, this study proposes a new vision of the duty to inform in a doctor-patient relationship, treating information as an autonomous obligation, that, per se, results in liability in the case of its absence or flaws. The compensation, in such perspective, arises from breach of the right to autonomous choice: if self-determination is a characteristic of the patients personality, the disrespect of this right results in damages subject to indemnification. Therefore, the limits of the duty to inform perform a relevant role since they demarcate the fine line that distinguishes flawed information (that can incur liabilities) from that transmitted diligently. Thus, the contents and the extension of the information were addressed, comparing subjective and objective aspects and seeking a solution at the same time viable (from the practical viewpoint), legal and just. Since this study essentially deals with the duty to inform in the doctorpatient relationship and of the legal consequences derived from noncompliance of this duty, all factors that compose this complex link were carefully examined, reviewing its historical evolution, the principles, values and rights that permeate and elucidate this relationship and, finally, the parties involved. Legal evidential procedures related to fulfillment of the duty to inform were also examined. Various controversial topics such as the refusal to undergo treatment, the right to not be informed, therapeutic privilege, among others, were also discussed.

Objetivos: verificar se indivíduos que acessam a Internet a utilizam para consultar informações sobre saúde e doenças; se o paciente, acessando a Internet muda sua atitude de paciente e se verifica mais ativo e mais participante do processo de decisão sobre sua saúde; e se, do ponto de vista do paciente, houve mudança na atitude do profissional médico frente ao maior uso da Internet por parte desse paciente. Metodologia: pesquisa com abordagem qualiquantitativa. A técnica empregada foi a do Discurso do Sujeito Coletivo – DSC, que possibilita a identificação e a construção de sujeitos e discursos coletivos distintos, por meio da análise de material individual e da extração das idéias centrais, compondo-se, com o conteúdo das idéias centrais semelhantes, discursos-síntese que expressam as representações sociais de uma coletividade. Para a coleta de dados foi publicado na Internet um questionário on-line que ficou disponível por três meses. Resultados: A maioria dos entrevistados acessa a Internet com freqüência de pelo menos uma vez por semana, a utiliza para consultar informações sobre saúde e doenças, informações relacionadas a casos vivenciados por eles ou por aqueles que os afetam diretamente (familiares) e, após alguma consulta médica, para verificar, entender ou complementar as informações oferecidas por seus médicos. Parte significativa dos entrevistados considera que as informações acessadas na Internet sobre saúde e doenças são úteis, utiliza tais informações para conversar com seus médicos em consultas posteriores e demonstra mudança de atitude, para uma postura mais participativa no processo de decisão sobre sua saúde. Conclusão: identificou-se uma diversidade de discursos coletivos distintos que, analisados e organizados em tipos e escalas, auxiliam na compreensão de questões tais como o tipo de participação do paciente durante a consulta médica, o grau de autonomia do paciente, os tipos de interação entre médico e paciente e os tipos de reações produzidas pelos profissionais médicos durante tal processo. / This research aims to verify whether individuals who have access the Internet use it to consult information on health and diseases; whether accessing the Internet changes the attitude of the patient and whether he becomes more active and more participant in the decision process about his health; and whether from the standpoint of the patient there were changes in the attitude of the medical professional as a consequence of the more intense use of the Internet by this patient. Procedure: research with quali-quantitative approach. The employed technique was the Speech of Collective Citizen - DSC, which allows the identification and construction of distinctive citizens and collective speeches through the analysis of individual material and the extration of the main ideas, composing, with the content of similar central ideas, speech-synthesis which express the social representations of a collective. For the data collection an on-line inquiry was published in the Internet and it was available for three months. Results: most of the interviewed individuals had frequent access to the Internet at least once a week, use it to consult information about health, diseases and information regarding medical cases experienced by them or by other people who affect them directly (relatives), and after some medical consultation, to verify, to understand or to complement the information offered by their doctors. A significant part of the interviewed ones consider that the information accessed in the Internet about health and diseases is useful, use such information to talk to their doctors in subsequent consultations and manifest an attitude change towards a participating position in the decision process about their own health. Conclusion: there is a diversity of distinctive collective speeches that, analyzed and organized in types and scales, assist in the understanding of questions such as the type of participation of the patient during the medical consultation, the degree of autonomy of the patient, the types of interaction between doctor and patient and the types of reactions produced for the medical professionals during such process.

This study explored the relationship between patients' Health Locus of Control and their perceptions about the nature of their physician-patient relationship. The Locus of Control Scale and the Multidimensional Health Locus of Control Scale were implemented to measure the degree of personal control individuals attribute to their health. The Health Care Climate Questionnaire was used to measure the perceived physician support. The predicted result of the study was that patients who exhibit a higher degree of internal health locus of control would report better relationships with their physicians. This hypothesis was confirmed; there was a positive relationship between Internal health Locus of Control and the Health Care Climate questionnaire. Also, a significant relationship between the Powerful Others subscale of the health Locus of Control and perceived physician support was established.

Ziel: Die beiden primären Ziele der Diabetes-Therapie sind eine möglichst optimale Einstellung des Blutzuckers sowie der Erhalt einer vergleichsweise guten Lebensqualität. Für beide Therapieziele konnte eine Vielzahl somatischer und psychischer Determinanten identifiziert werden. Relativ wenig Beachtung fand in diesem Kontext jedoch bislang die Bedeutung der therapeutischen Beziehung. Die vorliegende Dissertation untersucht, inwieweit ein unmittelbarer Zusam-menhang zwischen der Behandlungszufriedenheit der PatientInnen und den beiden anvisierten Therapiezielen besteht. Methodik: 650 PatientInnen (475 Insulin-behandelt, 171 nicht Insulin-behandelt) aus einer universitären Poliklinik, 3 Schwerpunktpraxen und 28 hausärztlichen Einrichtungen wurden befragt. Zur Erfassung der therapeutischen Beziehung wurde die Medical Interview Satisfaction Scale (MISS) verwendet, die Lebensqualität wurde mit dem WHOQOL-BREF gemessen und die Beurteilung der Blutzuckereinstellung erfolgte durch HbA1c-Werte. Die Darstellung der Ergebnisse erfolgte getrennt für mit und ohne Insulin behandelte PatientInnen. Ergebnisse: Für keines der beiden Subkollektive konnte ein Zusammenhang zwischen therapeutischer Beziehung und Blutzuckerkontrolle gefunden werden. Hingegen zeigte sich für beide Therapiegruppen eine signifikante Beziehung zu verschiedenen Aspekten der subjektiv wahrgenommenen Lebensqualität. Schlussfolgerungen: Unterschiede in der Blutzuckereinstellung waren mit der gewählten Methodik sowie dem verwendeten Konstrukt (Behandlungszufriedenheit) in dieser naturalistischen Studie nicht aufzuzeigen und ein Einbeziehen weiterer Dimensionen der therapeutischen Beziehung, insbesondere der ärztlichen Perspektive und der jeweiligen Interaktion, erscheint für weitere Untersuchungen wünschenswert. Auch wenn die signifikanten Ergebnisse in der Interaktion mit Lebensqualität z.T. als gemeinsame Kovarianz zu verschiedenen Persönlichkeitsmerkmalen interpretiert werden können, ergeben sich deutliche Hinweise, dass die therapeutische Beziehung ein Einflussfaktor der gesundheitsbezogenen Lebensqualität ist. / Objective: The primary goals in treating Diabetes are maintaining blood glucose levels as close to normal as possible and making a relatively normal quality of life achievable. A multitude of somatic and psychological determinants for both of these goals could be identified. However, relatively little consideration in this context was given to the importance of the doctor-patient-relationship. This study examines, whether a direct relationship between treatment satisfaction and the primary treatment goals exists. Methods: 650 patients (475 insulin-treated, 171 not insulin-treated) from one universitary outpatient centre, 3 specialized treatment facilities and 28 general practitioners were asked. The doctor-patient-relationship was assessed using the Medical Interview Satisfaction Scale (MISS), health-related quality of life was measured by the WHOQOL-Bref and metabolic control by HbA1c values. Results are presented separately for patients treated with and without insulin. Results: For none of the two subgroups a relationship between doctor-patient-relationship and metabolic control was detected. However, significant interactions were found for both collectives regarding different aspects of quality of life. Conclusions: Differences in metabolic control could not be shown using the chosen methods and the construct treatment satisfaction under routine conditions and further dimensions of the doctor-patient-relationship as the physician's perspective and interactional aspects are likely to be included in future studies. Even while the significant results concerning the interaction with quality of life can be interpreted as a common covariance regarding various personality dispositions there are clear indications that the doctor-patient-relationship is a determinant of health-related quality of life.

Made available in DSpace on 2016-07-27T14:21:15Z (GMT). No. of bitstreams: 1 Adriana Regina de Oliveira.pdf: 233420 bytes, checksum: 01118a5386ee3d15f5fd46bf2c35ef85 (MD5) Previous issue date: 2006-10-11 / The purpose of this study was to identify the possible functional categories of smoking patients verbal reports about their difficulties in quitting smoking in an ambulatory context. It was also identified the functional categories of the doctor s role in supplying necessary information to the patient on damages made by the use of cigarettes. For such, it was adopted a descriptive methodology through direct observation of behaviors registered in video to identify possible behavior categories at the moment of the doctor appointment. Three doctors and nine patients from a private hospital ambulatory had participated in this study, being three patients of each participant doctor. The appointments were registered in video and were properly authorized to be used by the patients and doctors. The sessions were transcribed after recorded. After a careful study on these transcriptions, it was initiated the identification of verbal and non verbal categories of smoking patients on smoking behavior, as well as verbal categories of doctor s performance in relation to such patients. Seven categories of patient s verbal actions and eighteen of non-verbal actions were selected. It was also selected five categories referring to doctor s verbal actions. Later on some categories were divided in subcategories. The results had indicated a high frequency in the speech of smoking patients indicating symptoms and illnesses, amongst others. Also, the results had demonstrated that smoking patients reported to doctors their negative emotional situation as a reason to continue making use of tobacco. The data still show that doctors practically do not inform patients about anti-smoking treatments, and they do not encourage them to abandon the addiction. These data was discussed on the extreme importance of doctors role on informing, advising, or encouraging their patients about anti-smoking treatments, since these actions can contribute to improve health and quality of life for many people. Although it is likely that the majority of patients wants to quit smoking, but is not able to, as it was demonstrated in this study. / O objetivo do presente estudo foi identificar as possíveis categorias funcionais dos relatos verbais dos pacientes tabagistas sobre suas dificuldades em abandonar o uso do cigarro em um contexto ambulatorial. Procurou-se também identificar as categorias funcionais da atuação do médico no sentido de fornecer as informações necessárias ao paciente sobre os malefícios do cigarro. Para tal optou-se por uma metodologia descritiva através da observação direta de comportamentos registrados em vídeo para identificar as possíveis categorias comportamentais presentes no momento da consulta médica. Participaram deste estudo três médicos e nove pacientes provenientes do ambulatório de um hospital particular, sendo três pacientes de cada médico participante. As consultas foram registradas em vídeo, após autorização por escrito, dos médicos e pacientes participantes. Após a obtenção do registro em vídeo, todas as sessões foram transcritas. De posse das transcrições e após várias leituras destas, procedeu-se a identificação das categorias verbais e nãoverbais dos pacientes tabagistas sobre o comportamento de fumar, bem como as categorias verbais referentes à atuação dos médicos em relação a tais pacientes. Foram selecionadas sete categorias em relação às ações verbais e 18 das ações nãoverbais dos pacientes, também cinco categorias referentes às ações verbais dos médicos. Posteriormente algumas categorias foram divididas em subcategorias. Os resultados indicaram uma alta freqüência de falas dos pacientes tabagistas indicativas de sintomas e doenças, dentre outras. Os resultados demonstraram que os pacientes tabagistas relataram aos médicos seus estados emocionais negativos como justificativa para continuar fazendo uso do tabaco. Os dados mostram ainda que os médicos praticamente não informaram aos pacientes sobre tratamentos antitabagismo, bem como não os incentivaram a abandonar o vício. Os dados foram discutidos em relação à extrema importância da atuação médica no sentido de informar, aconselhar ou incentivar seus pacientes sobre tratamentos antitabagismo, sendo que estas ações poderão contribuir no sentido de melhorar a saúde e a qualidade de vida de muitas pessoas. Contudo é previsível que a maioria dos pacientes quer abandonar o cigarro, mas não consegue como demonstrou os dados do presente estudo.

Made available in DSpace on 2016-04-28T20:39:00Z (GMT). No. of bitstreams: 1 Laura Marques Castelhano.pdf: 1955754 bytes, checksum: eb80f8fb5a15633ac54be0a9b22ade47 (MD5) Previous issue date: 2015-03-13 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The purpose of the research was to investigate the emotions of the doctor and their perception of the patient that affects him. This study used a multimethod research and evaluated in quantitative phase, thirty (30) doctors serving in office. For the qualitative phase were chosen four (4) doctors for an in-depth interview as a Case Study. The instruments used for the analysis were: sociodemographic questionnaire, the Inventory of Stress Symptoms for Adults Lipp (ISSL) and the International Affective Picture System (IAPS) and a semi-structured interview. The results showed that 56.7% of doctors experienced symptoms of stress, which is an index within the expected parameters of the test and there was no relationship between the sociodemographic variables. In relation to emotional perception there was no difference between the sample results and the general population, but differences were found in the relation to sociodemographic variables: age, time since graduation, average handle time (consultation) and weekly hours devoted to work in the office, concluding that older doctors, with more time after graduation and more time in consultation with the patient, felt more impacted on the emotional stimuli than other doctors; and doctors who work more hours per week in the office perceived the stimuli in a less pleasant way than other doctors. These data were confirmed by groups of four (4) clusters. It was conducted by a case study following the approach of Jungian theory with a representative of each cluster from pre-set categories related to the research objectives, content and factors attributed to stress; emotional perception; the role of emotion in the doctor-patient relationship; the emotions aroused by difficult patient and not difficult patient and strategies for dealing with emotions. The results revealed that the emotions could influence attitudes and perceptions in the medical activity. There was a suffering from physicians due to an emotional wound that is not recognized and poorly understood, which can result in projections in patients / O objetivo da pesquisa foi investigar as emoções do médico e a percepção do paciente que o afeta. Este estudo utilizou o método misto de pesquisa e avaliou na fase quantitativa, 30 (trinta) médicos com atuação em consultório. Para a fase qualitativa foram escolhidos 4 (quatro) médicos para a entrevista aprofundada em forma de Estudo de Caso. Os instrumentos utilizados para a análise foram: o questionário sociodemográfico, o Inventário de Sintomas de Stress para Adultos de Lipp (ISSL) e o International Affective Picture System (IAPS) e a entrevista semiestruturada. Os resultados mostraram que 56,7% dos médicos apresentaram sintomas de estresse, índice dentro do esperado pelos parâmetros do teste e não houve relação entre as variáveis do sociodemográfico. Em relação à percepção emocional não houve diferença entre os resultados da amostra e a população geral, mas houve diferença na relação com as variáveis sociodemográficas: idade, tempo de formado, tempo médio de atendimento (consulta) e horas semanais dedicadas ao trabalho no consultório, concluindo-se que médicos mais velhos, com mais tempo de formado e que ficam mais tempo em consulta com o paciente, sentiram-se mais impactados diante dos estímulos emocionais do que os outros médicos; e os médicos que trabalham mais horas semanais no consultório perceberam os estímulos de forma menos prazerosa que os outros médicos. Esses dados foram confirmados pelos agrupamentos dos 4 (quatro) clusters. Efetuou-se a análise de caso segundo a abordagem da teoria junguiana com um representante de cada cluster a partir de categorias pré-estabelecidas relacionadas aos objetivos da pesquisa: índice e fatores atribuídos ao estresse; a percepção emocional; o papel da emoção na relação médico-paciente; as emoções despertadas pelos pacientes difícil e o que não desperta dificuldades e estratégias para lidar com as emoções. Os resultados revelaram que as emoções podem influenciar atitudes e percepções na atividade do médico. Observou-se um sofrimento por parte dos médicos decorrente de uma ferida emocional que não é reconhecida e que encontra pouco espaço para ser compreendida, passível de ocasionar projeções nos pacientes

Britain's Asians are a young population and their socio-economic status is low, with racial disadvantage in housing, employment, education and health. Research on their health has usually not been conducted in its socio-economic and demographic context and there is little on their use of primary care. Three studies were conducted to investigate their relationship with primary care in Bradford. A study of general practice attenders of white/British, Pakistani and Indian origin confirmed the demographic and socio-economic differences between the groups. The former had higher rates of alcohol and cigarette consumption. For Pakistanis and Indians, fluency and literacy in English was poor. Ethnic and linguistic match between doctor and patient was more important in patients' choice of doctor than the doctor's sex. Differential employment status of Asian and white/British accounted for some of the differences in health. A study of general practice attendance showed similar rates of surgery consultations between Asians and Non-Asians; the latter made greater use of domiciliary services. Both these studies were conducted in an inner Bradford health centre with an Asian male, a white male and a white female doctor. Bradford GPs were found to perceive that Asian patients made greater use of surgery and domiciliary consultations; attended more often for trivial complaints; and had lower compliance rates than Non-Asians. These perceptions were not supported by objective data. Better qualified GPs had a smaller, and Asian doctors had a greater proportion of Asian patients on their lists. Research, and action on Asians' health, needs to take account of their poorer socio-economic status.

La loi du 04 mars 2002 relative aux droits des malades et à la qualité et à la qualité du système de santé et la loi HPST (Hôpital, Patients, Santé et Territoires) de 2009 qui accorde un cadre légal à l’éducation thérapeutique ont promu l’autonomie du patient en favorisant sa participation aux décisions médicales. L’autogestion de la maladie chronique voulue par les pouvoirs publics en fournissant ces outils juridiques pour améliorer la qualité de soins, a suscité notre intérêt pour programme d’éducation thérapeutique destiné à des patients insuffisants rénaux en pré-dialyse. L’un des objectifs est de favoriser la liberté des patients à choisir une méthode de dialyse. Dans notre travail de thèse, nous avons voulu montrer comment les déterminants sociaux des décisions médicales et ceux liés aux choix d’une méthode de dialyse sont construits. Si en France, les patients semblent davantage se tourner vers une prise en charge à l’hôpital, dans certains pays, c’est le pluralisme médical qui est de mise. L’exercice de l’auto-analyse a montré le poids de l’économique, de la culture, de la famille dans les choix de santé.Par ailleurs, la place de l’éducation thérapeutique dans le processus décisionnel n’est pas figée : l’éducation thérapeutique peut être complémentaire à la pratique médicale, être un outil d’aide à la décision pour certains patients insuffisants rénaux ou être utilisée par les médecins pour favoriser l’observance décisionnelle des patients. Nous avons montré que les patients et les médecins se basent sur plusieurs facteurs qui peuvent influencer la nature de la délibération.Cette étude a montré que le choix est réseauté et que les décisions sont construites car elles sont basées sur des interactions et des stratégies médicales. Ces déterminants permettent également de comprendre comment la confiance est construite dans le processus décisionnel. Tantôt distribuée, tantôt déplacée, la confiance est explicative du type d’information que le patient priorise. Le choix réseauté du patient amène finalement à la relativisation du modèle de décision médicale partagée qui semble de plus en plus avoir un caractère normatif dans la relation entre professionnels de santé et patients. / The law of March 04th, 2002 on the rights of patients and the quality of the health system and the law HPST (Hôpital, Patients, Santé et Territoires) of 2009 that grants legal framework for patients’ education, have promoted the patient’s autonomy by encouraging his participation in medical decisions. Self-management of chronic illness as favoured by public authorities in providing the legal tools to improve the quality of care has aroused our interest in patient education programs for patients with renal failure in pre-dialysis. One of the objectives of this program is to allow patients free choice when deciding on the method of dialysis.Our thesis aims to underline how the social determinants at work in medical decisions and those involved in the choice of a dialysis method are constructed.In France, patients seem to favor hospital patient care, but in some countries, medical pluralism is more frequent. The exercise of self-analysis has revealed the significant part played by economy, culture and family in health choices.Moreover, the part played by patient education in the decision-making process is neither fixed nor pre-determined: patient education can complement medical practice, can be a decision support tool for some kidney patients or be used by doctors to promote patient decision-making compliance.We have shown that patients and physicians rely on several factors that may influence the nature of the discussion.This study reveals that the choice is networked and that the decisions that are made are the outcome of several interactions and medical strategies. These determinants also help to understand how trust develops and leads to decision-making.Sometimes distributed, sometimes shifted, trust accounts for the type of information prioritized by the patient. The networked choice of the patient finally puts the shared decision-making model into perspective as it increasingly seems to have a normative character in the relationship between health professionals and patients.

[pt] A relação médico-paciente consiste numa díade que é hierarquicamente assimétrica. Uma parte cuida e a outra recebe cuidado, análogo ao que ocorre nas relações de apego. O médico teria o papel de figura de apego, possibilitando ativar o seu sistema de cuidado. O objetivo deste estudo é analisar como o sistema de cuidado está inserido na relação médico-paciente, analisando o estilo de apego do médico, além de relacioná-lo à capacidade de cuidado que o médico tem com seu paciente. Foram entrevistados onze hematologistas do Rio de Janeiro e São Paulo com experiência no SUS utilizando um roteiro de entrevista semiestruturado e foi aplicado o instrumento de autorrelato EVA (Escala de Vinculação do Adulto). Após análise de conteúdo das entrevistas e análise por clusters do EVA, os médicos entrevistados apresentaram apego seguro, com aspectos defensivos evitativos e amedrontados. Quatro categorias também foram estabelecidas: experiências pessoais com medicina e/ou hematologia; especificidade da hematologia; como lidar com as questões sobre perdas; e cuidado com o outro. Conclui-se que o presente trabalho prioriza o lado do médico nesta relação, e a importância do atendimento às suas necessidades psicológicas e relacionais. Com isso, intervenções podem ser propostas à equipe de saúde, de forma a cuidar de maneira consistente destes profissionais e aprimorar sua relação com o paciente e seus familiares. / [en] The doctor-patient relationship consists of a hierarchically asymmetrical dyad. One side cares and the other receives care, analogous to the attachment relationship. The doctor would have the attachment figure s role, being able to activate his or her caregiving system. The purpose of this study is to analyze how the care system is inserted in the doctor-patient relationship, analyzing the attachment style of the physician in addition to relating it to the care ability that the doctor has with his/her patient. Eleven hematologists from Rio de Janeiro and São Paulo with experience in SUS were interviewed using a semi-structured interview script and the self-report instrument AAS-R (Adult Attachment Scale-Revised) was applied. After content analysis of the interview and a cluster analysis of the AAS-R, all the doctors presented secure attachment, with avoidant-dismissing and avoidant-fearful defensive aspects. Four categories were also analyzed: personal experiences with medicine and/or hematology; hematology s specificity; how to deal with loss; and caring towards other. We concluded that the present it is important to prioritize the doctor s stance in the relationship, and to attend their psychological and relational needs. In that manner, interventions in the healthcare team can be proposed, providing the proper care to the healthcare professional, and, hence, improve their relationship with patients and their family members.

Contexte. Objectifs principaux : explorer l’expérience vécue vécu des neurologues et des patients des annonces de mauvaises nouvelles dans la sclérose en plaques, le vécu de la pathologie ainsi que de la qualité de leur relation dans le contexte du suivi d’un projet thérapeutique, et d’envisager la création d’un outil clinique réflexif pour les neurologues destiné à contribuer au maintien d’une relation de qualité durant l’ensemble du parcours de soins. Méthodologie. Étude qualitative multicentrique ; analyse des verbatims : 63 entretiens cliniques de recherche - 35 patients et 20 entretiens - 20 neurologues ; 3 entretiens - relecture d’items ; triangulation méthodologique ; triangulation des observateurs/résultats ; analyse IPA et analyse clinique d’orientation psychodynamique. Résultats. Les annonces de mauvaises nouvelles dans la SEP sont vécues comme des expérience anxiogènes pour la majorité des neurologues de la recherche, des situations source de frustration et parfois d’impuissance. Les impacts psychiques engendrés par les annonces de mauvaises nouvelles, la perception dans certains cas d’une relation au médecin dénuée d’empathie, le sentiment d’impuissance lié au caractère imprévisible de l’évolution de cette maladie progressivement handicapante ainsi qu’une défiance quant à l’efficacité des traitements proposés expliquent en partie la fragilité de l’alliance thérapeutique avec le neurologue et les réactions psychologiques parfois extrêmes des patients qui en découlent. Conclusion et ouverture. Résultats obtenus : engager une réflexion éthique sur les informations à transmettre au patient, et proposer une formation aux neurologues basée sur l’outil élaboré / Context. This research aims to explore the neurologist’s and patient’s lived experiences of breaking bad news in multiple sclerosis and the lived experience of this disease, to understand the basic conditions of their relationship, and to create reflective clinical tools aimed at helping neurologists to maintain the quality of their relationship with the patients. Methodology. Multicentre qualitative study presents the results obtained from the analysis of 83 clinical research interviews with 35 patients and 20 neurologists, using IPA and a clinical psychodynamic. Results. Breaking bad news (BBN) in multiple sclerosis are lived as stressful experience for the majority of the neurologists of the research, a situations lived with frustration and sometimes powerlessness. Psychic impacts engendered by the BBN, the perception in certain cases of a relation to the doctor divested of empathy, the feeling of powerlessness linked to the unpredictable character of the evolution of this gradually crippling disease as well as a mistrust as for the efficiency of the proposed treatments explain partially the fragility of the therapeutic alliance with the neurologist and sometimes the extreme psychological reactions of the patients. Conclusion and opening. Results obtained : engage an ethical reflection on the information to transmit to the patient, and to suggest training to neurologists based on the tool created in tis research