Les avatars des soins palliatifs désenclavés. Enquête en unités de soins palliatifs, en équipes mobiles et en services de soins curatifs

International audienceObjectivesDisseminating the “palliative approach” to all hospital services which have to deal with the end-of-life is a major feature of the development of palliative care in France. The aims of this article are to examine the ways in which palliative care, increasingly integrated into hospital's activity, are configured in French hospitals.MethodsThe data was collected through individual semi-structured interviews with 64 caregivers and volunteers working in three distinct organizational frameworks: palliative care units, palliative care supportive teams and curative care services.ResultsThe principal results highlight a diversity of working configurations, reflecting the heterogeneity of the palliative care world (as concerns both its conceptions and practices of end-of-life care), and show that the debates which run through the palliative care teams tend not only to persist, but also to become more acute, as this activity unfolds in an open environment.ConclusionIf it is possible to act on certain factors to improve the dissemination of the “palliative approach” in hospital services (such as by training health care providers or by reorganizing the services), two other frequently underestimated factors tend to discourage changes in practice: the limited time in which the staff has to perform multiple tasks and the actual capacity of each professional “to care for the dying”.Objectifs La diffusion de la « démarche palliative » à tous les services hospitaliers confrontés à la fin de vie est un axe majeur de la politique de développement des soins palliatifs en France. L’objectif de cet article est d’interroger les façons dont l’activité palliative, de plus en plus désenclavée, se configure aujourd’hui dans les hôpitaux français. Méthode Les données ont été recueillies par entretiens semi-directifs individuels auprès de 64 soignants et bénévoles, exerçant dans trois cadres organisationnels distincts : des unités de soins palliatifs, des équipes mobiles et des services de soins curatifs. Résultats Les principaux résultats mettent en évidence une diversité de configurations de travail, reflétant l’hétérogénéité du monde des soins palliatifs (tant conceptuellement, que dans ses pratiques), et montrent que les débats qui parcourent les équipes de soins palliatifs non seulement persistent, mais aussi s’accentuent, lorsque cette activité se déploie dans un milieu ouvert. Conclusion S’il est possible de jouer sur certains facteurs pour diffuser la « démarche palliative » dans les services (comme la formation des soignants ou une révision de l’organisation des services), deux autres, souvent sous-estimés, jouent comme des freins dans l’inflexion des pratiques : le temps incompressible dont le personnel dispose pour réaliser ses multiples tâches et la capacité réelle de chaque professionnel à « s’occuper de mourants ». SummaryObjectives Disseminating the “palliative approach” to all hospital services which have to deal with the end-of-life is a major feature of the development of palliative care in France. The Aims:of this article are to examine the ways in which palliative care, increasingly integrated into hospital's activity, are configured in French hospitals. Methods The data was collected through individual semi-structured interviews with 64 caregivers and volunteers working in three distinct organizational frameworks: palliative care units, palliative care supportive teams and curative care services. Results The principal results highlight a diversity of working configurations, reflecting the heterogeneity of the palliative care world (as concerns both its conceptions and practices of end-of-life care), and show that the debates which run through the palliative care teams tend not only to persist, but also to become more acute, as this activity unfolds in an open environment. Conclusion If it is possible to act on certain factors to improve the dissemination of the “palliative approach” in hospital services (such as by training health care providers or by reorganizing the services), two other frequently underestimated factors tend to discourage changes in practice: the limited time in which the staff has to perform multiple tasks and the actual capacity of each professional “to care for the dying”