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Continuous deep sedation at home: Evaluation of practices

Par : Contributeur(s) : Type de matériel : TexteTexteLangue : français Détails de publication : 2024. Ressources en ligne : Abrégé : Background: The Claeys-Leonetti law of February 2, 2016, creating new rights for the sick and people at the end of their life, provides for the state of continuous and deep sedation maintained until death. It offers patients the opportunity to “choose their final home on earth.” The majority of French people would prefer to die at home, but this involves certain preconditions and organizational requirements. Objective: Determine if the recommendations have been applied during the implementation of deep and continuous sedation maintained until death at home and identify the barriers to the application of these recommendations. Methods: Observational, descriptive study, carried out by directed questionnaire, among general practitioners (GPs) and nurses who contributed to the implementation at home of a deep and continuous sedation maintained until death between 2016 and 2019, supported by the ARPEGE Palliative Care Network. The questionnaire was submitted to GPs and nurses from June to October 2022 via telephone. The evaluation was carried out based on ten criteria defining the quality of the performance of sedation. Results: We collected 26 accounts of sedation. On average, 7.6 of the ten criteria studied were followed. The provisions of the law were relatively well applied, particularly when it came to the designation of a trusted person, the information received by the patient, and the initiation of sedation by a nurse in the presence of a doctor. However, the lack of availability and foresight on the part of health care professionals has sometimes led to difficulties. Conclusion: To ensure a quality palliative approach, health care professionals must be trained in palliative culture, and family members must be informed and supported. Caregivers need to be trained and supported by the expertise of a palliative care resource team. Anticipating end-of-life situations is key. This helps to ensure quality palliative care at home.
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Background: The Claeys-Leonetti law of February 2, 2016, creating new rights for the sick and people at the end of their life, provides for the state of continuous and deep sedation maintained until death. It offers patients the opportunity to “choose their final home on earth.” The majority of French people would prefer to die at home, but this involves certain preconditions and organizational requirements. Objective: Determine if the recommendations have been applied during the implementation of deep and continuous sedation maintained until death at home and identify the barriers to the application of these recommendations. Methods: Observational, descriptive study, carried out by directed questionnaire, among general practitioners (GPs) and nurses who contributed to the implementation at home of a deep and continuous sedation maintained until death between 2016 and 2019, supported by the ARPEGE Palliative Care Network. The questionnaire was submitted to GPs and nurses from June to October 2022 via telephone. The evaluation was carried out based on ten criteria defining the quality of the performance of sedation. Results: We collected 26 accounts of sedation. On average, 7.6 of the ten criteria studied were followed. The provisions of the law were relatively well applied, particularly when it came to the designation of a trusted person, the information received by the patient, and the initiation of sedation by a nurse in the presence of a doctor. However, the lack of availability and foresight on the part of health care professionals has sometimes led to difficulties. Conclusion: To ensure a quality palliative approach, health care professionals must be trained in palliative culture, and family members must be informed and supported. Caregivers need to be trained and supported by the expertise of a palliative care resource team. Anticipating end-of-life situations is key. This helps to ensure quality palliative care at home.

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