End of life. In Toulouse, a future hospital wants to anticipate palliative care
In the next two or three years, a new national building for palliative care will see the light of day in Toulouse (Haute-Garonne). Its specificity? Provide the patient with treatment as early as possible. “Today, our intervention depends on the stage of the disease, or we can intervene earlier in the treatment, to help the patient live better”, says Nicolas Saffon, geriatrician and head of Resonance (mobile team, pain, palliative care and support care at Toulouse University Hospital).
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“Manage symptoms of discomfort”
In this future establishment, which will be both a traditional hospital structure and a day hospital, patient support will be provided in parallel with their treatment. Currently, admission to palliative care takes place when the patient is at the end of life, on average he remains there for eighteen days. However, between the moment when the medical team knows that the disease is not curable, either because it is too advanced, or because the patient does not react to treatment and the patient’s death, there may be a much longer time. “We want to take care of the symptoms of discomfort with the aim of developing the patient’s autonomy and quality of life”, he continues. Concretely, it is established that the more a patient is relieved, the better he will be able to appropriate his daily life and his future. He will thus be better able to make choices: how far does he plan to follow care? What limit does he set himself in relation to the undesirable effects of the treatment? “All these decisions are easier to make when it’s not in a hurry”, he continues.
The idea is to start offering this palliative care offer within the framework of the day hospital, where the graduates generally take place, without shocking the patient. Because that is where the difficulty lies: how to treat the palliative care associated in the collective imagination with death? How to make them switch from a negative image to a positive image, like palliative care primarily intended to help people live as well as possible? “Perhaps there is work to be done in the very name of palliative care, which has too many negative connotations”, asks Nicolas Saffon.
In the future establishment, multidisciplinary teams formed in addition to health personnel, dieticians, psychologists, social workers, physiotherapists or socio-estheticians will work together with the patient. “It is this holistic (global) approach that best corresponds to the idea that I have of patient care”, illustrates Rebecca Ouwanssi, nurse in the palliative care department of the CHU Pierre-Paul Riquet in Toulouse. Volunteer, like all his colleagues, to work in this service.
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Patient groups to help each other
To complete the system, it is also planned that patients meet in groups to help and support each other: “They can have a lot to learn from each other and bring to each other”, believes Nicolas Saffon. Indeed, patients do not all react in the same way when they discover that they cannot be cured. To the feelings of anger and injustice felt by some, others, more peaceful, organize their burial, write announcements, write letters to their children or grandchildren, to give them when they turn 18 or will be the parents in turn. “Their state is not linear”, specifies the nurse, they can go from one emotion to another, from denial to acceptance, and vice versa.
If she places listening as a cardinal quality of the caregiver, she has undergone training in palliative care within the hospital to better support patients and their families. One of her colleagues has a university degree in palliative care, “She brings us a lot, especially in pain management and support. Everyone has to pass it.” she believes.
The team meets regularly to discuss cases, this allows everyone to take a step back from proven situations, to find the right distance. “The general public’s idea of palliative care is completely wrong. The end of life is not always sad, chaotic and horrible”, insists Rebecca Ouwanssi. Understand it and accept it “would be reconciled with death”, she thinks.