Palliative care, a positive change in the minds of French

Once associated with a failure of medicine face death, palliative care now convey a positive image of the refusal of suffering, according to studies on social representations of care presented by the French Company and accompanying care palliative (RFS) and the Fondation de France.

Denial of suffering before death

The Palliative Care Unit of the Hospital Cognac-Jay (Paris) caters for the majority of the beds of patients with end-stage cancer, explains Dr. Luc APM Plassais, head of service.

In this rather special unit, where the animals are allowed to visit, everything is done for the patient regains some of his "home": an aviary in the lifts to brighten the hallway, a common living room furniture that "homemade" to reunite the family room where the wood is preferred, and wifi that "if this is to some, it is already important."

And as almost all rooms are oriented towards the garden, residents can "see the greenery of bed", or even watch the people in the neighborhood, such as schoolchildren, etc...", because this space is open it connects two streets. Even if it is a place where people die, "was always the idea of being in life, said Dr Plassais.

The Paris hospital hosted a press conference to present the results of two studies, one qualitative (Wei) and other quantitative ** (Ipsos) on palliative care and social representations, made at the request of RFS and the Fondation de France.

Nearly nine out of 10 French consider that palliative care is now "a necessary suffering of seriously ill or dying response," Ipsos study reveals. And about the same proportion believe that these treatments allow seriously ill patients to "live more serenely the end of their life" or "death with dignity".

Before, the word referred to a palliative disability, a lack of medicine against death. Now, palliative care is no longer associated with death, but the refusal of suffering, whether physical, emotional or psychological, recalls Alain Mergier, director of the institute Wei.

Thus, "the image of palliative care is driven by the current ethics of the person, the heart of the current socio-cultural developments. Palliative care is as such a sign of human medicine more oriented towards the patient to his disease, "analyze the Fondation de France and Wei Institute in synthesis.

Yet, when asked about the conditions of access, the content of care or repayment of palliative care, two-thirds are French to estimate misinformed. The feeling of being well informed increased significantly with the age of respondents, from 25% at the age of 35 to 37% for those aged 35 and over, and even 52% in 70 years and more.

"With age, the level of confrontation with death increases logically and with it, a sense of involvement. Undoubtedly, the elderly are also more likely to have been faced with a situation where a loved one has been taken into supported by a palliative care unit, "commented the RFS and the Fondation de France in a file given to the press.

"There is a kind of progressive degree in the full reality of understanding of palliative care," said Alain Mergier.

At one level, palliative care is viewed simply as a "caring attitude on the part of caregivers, nurses, carers and doctors. At the top level, respondents are added" the involvement of specific medical expertise around the entire end of life. "It is only in those who had an experience of palliative care or special information that the notion of" organization of special devices in hospitals "dedicated to health care.

Palliative care: for whom, how and who pays?

Half of French think all seriously ill or dying do not have the ability to access palliative care, note the Ipsos study.

Indeed, in the minds of respondents, many questions remain about the availability, management and funding of palliative care, explains Wei Institute.

"Palliative care has a picture of costly process (...) The interviewees think that cost partly borne by the patient. They evoke mutual, of course, but 'premium' and therefore socially discriminating," said Will there.

In addition, "the public does not think the provision of palliative care evenly distributed on the territory. It assumes that some physicians express moral, economic reluctance, organizational," says the institute.

While the process is open to "all those whose condition requires", and is "fully supported by health insurance", and that the laws of June 1999 and April 2005 (Leonetti law) defined and strengthened the "right of individual patients around the end of life," the territorial distribution of palliative care remains largely insufficient and uneven.

The device palliative care focuses on specialized resources, says Dr. Godfrey Hirsch, President of the RFS.

At the hospital, this device includes palliative care units (USP), devolved to the reception of patients in complex situations, mobile palliative care teams (PMSC), which move with the teams to help them take manage patients in difficult situations, and the beds identified Hospice (LISP), he explains.

At home, still a poor relation of our system, it is the doctors and nurses Liberals, palliative care networks that support them, as well as the structures of home care, he says.

"And do not forget the accompanying volunteers who, by their presence full of humanity, are also there as witnesses to the social attention to the sick and the vulnerable," he concludes.

Promote access to palliative care

For years, Dr. Godfrey Hirsch wants to "promote access to palliative care" and then resumes the proposals had made the deputy Jean Leonetti in a report on the evaluation of the Act of 22 April 2005 on the end Life (December 2008).

It is first of all to develop the existing system, keeping in mind the objective of opening a USP department in 2013. "There are 57 departments lacking USP," says Dr. Hirsch.

It also calls for the strengthening of PMSCs and development of a network of palliative care for 400,000 people. "65 departments in France have not achieved this. This means you work remains to be done," he informs.

"Every year in France, about 150,000 people die as a result of a long and incurable disease, and require palliative care," says Dr. Hirsch.