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Freins et leviers à l’élaboration des directives anticipées en situation palliative

Abstract : An evolution of the law is undertaken in order to make advance directives judiciously enforceable and thus made more binding for the medical teams. However, in the practice of palliative cares, the nursing teams are often confronted to a refusal from the patients when they have to make an anticipated choice concerning the end of their life. Through a qualitative study by semi-directed interviews and a textual analysis of the speech of 12 patients in palliative situation and 10 of their relatives, we studied the brakes and levers in the drafting of advance directives in these patients. Beyond the transition to writing of directives, it is the elaboration of the ADs itself that is seemingly difficult for patients in a palliative situation. The impossibility of imagining or conceptualizing the time of death, although the prognosis is known, leads to an inability to write ADs. One of the challenges of these ADs, beyond their actual writing, would be to use them as a communication medium between patients or future patients and the medical team.The sharing of a possible end-of-life decision with relatives as well as with the medical teams, appears essential. These exchanges are part of a dynamic process taking into account the temporality of the patient but also the various evolutionary stages of the disease thus ensuring a better match between an experienced situation and ADs. ADs in the form of written documents do not conform to the wishes of the patients and relatives we interviewed.For relatives, regular early discussions outside of any pathological medical context seem to be a suitable way of collecting their wishes and values. The notion of anticipatory discussions and « advance care planning » associating the entourage, would appear to be more in line with the expectations of patients in a palliative situation. From an individual act of writing, reflecting the expression of autonomy of the individual, we should tend towards a more systemic approach.
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Submitted on : Thursday, October 24, 2019 - 12:03:55 PM
Last modification on : Wednesday, November 3, 2021 - 9:59:52 AM
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Catherine Lamouille-Chevalier. Freins et leviers à l’élaboration des directives anticipées en situation palliative. Santé publique et épidémiologie. Université de Lorraine, 2019. Français. ⟨NNT : 2019LORR0074⟩. ⟨tel-02331173⟩



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