La personne de confiance : analyse de sa posture dans notre pratique

Khetta, M; Guédon, E.; Martin, Donald A.; Bounacer, A.; Haas, St.

doi:10.1016/j.etiqe.2015.04.001

Cited by 3 publications

(3 citation statements)

References 15 publications

(10 reference statements)

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“…During recent years, an increasing number of patients covered by the French health system are nominating a HCP to speak on their behalf in anticipation of a time when they are no longer able to express themselves: 31% for cancer patients [ 17 ], 40.9% for dependent elderly people [ 17 ], and up to 64.5% for patients in a haematology department [ 14 ]. However, only a small percentage of patients write ADs in France: from 1.5 to 6% [ 12 , 18 – 20 ]. Patients in oncology and haematology departments typically have more severe disease, sometimes at an advanced stage, and are undergoing treatments, such as bone marrow allografts, which may be fatal.…”

Section: Discussionmentioning

confidence: 99%

Advance directives from haematology departments: the patient’s freedom of choice and communication with families. A qualitative analysis of 35 written documents

Trarieux-Signol

Bron

Ceccaldi³

et al. 2018

BMC Palliat Care

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BackgroundIn France, advance directives are favourably perceived by most of the population, although the drafting rate is low. This ambivalence is challenging because advance directives are meant to promote the autonomy and freedom of choice of patients. The purpose of this study was to analyse the content of advance directives written by patients suffering from malignant haemopathies to better understand how patients put them into practice. These could be relevant as early as the initial diagnosis of haematological malignancies because of the uncertain course of the disease.MethodsThis was a multicentre, qualitative, descriptive study. The advance directives written by patients with malignant haemopathies treated in one of the six French hospital departments were included in the study from 01/06/2008 to 15/04/2016. A thematic analysis of the advance directives was performed by two researchers: a senior haematologist and a research assistant.ResultsThe median age of the patients was 69. Most were women (sex ratio: 0.59), living as a couple (57%), with lymphoid pathologies (66%), who were still alive two years after the instructions were written (63%) and had nominated a health care proxy (88.6%). Free texts (62.9%) were richer in content than pre-defined forms. The advance directives were used in three ways: for a purely legal purpose, to focus on medical treatments or actions, or to communicate a message to the family. Three main themes emerged: (1) refusal of medical treatment (100%), in which patients express refusal of life-sustaining care (97.1%). The actual treatments or the moment when they should be limited or stopped were not always mentioned in detail. (2) A desire for effective pain relief to avoid suffering (57.1%) and (3) messages for their family (34.3%), such as funeral arrangements (17.1%) and messages of love or trust (14.3%).ConclusionsPatients who write advance directives are not necessarily at the end of their lives. Their content mainly conveys treatment wishes, although patients also use them to pass on personal messages to their close family. This emerging role of advance directives to communicate messages within the family should be valued, even if it is not their original purpose.

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Section: Discussionmentioning

confidence: 99%

Advance directives from haematology departments: the patient’s freedom of choice and communication with families. A qualitative analysis of 35 written documents

Trarieux-Signol

Bron

Ceccaldi³

et al. 2018

BMC Palliat Care

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“…The variability in how nursing homes convey information about the rights and responsibilities of trusted persons is consistent with ndings from other settings. In hospitals, most patients are not systematically informed by professionals about the tasks of the trusted person (Khetta et al, 2015;Péoc'h & Ceaux, 2009;Velter et al, 2016).…”

Section: Information Provided To Trusted Persons On Their Rights and ...mentioning

confidence: 99%

Professionals’ perspectives on trusted persons in French nursing homes

Faye-Ropaul,

Khalil

2024

Preprint

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Background France faces a growing challenge with an aging population and the rise of neurodegenerative disorders. To address this, French health law allows patients to appoint a trusted person ("personne de confiance") who can communicate their medical preferences if they become incapacitated. Introduced by the Kouchner Law in 2002, this reflects a shift from a paternalistic to an autonomist model of care, emphasizing patient autonomy. Despite the importance of trusted persons in conveying patient wishes, especially in nursing homes, research in this area remains limited, with most studies focusing on hospital settings rather than nursing homes. Methods Semi-structured interviews were conducted with 14 healthcare professionals working in or with nursing homes from February 2021 to September 2022, lasting 26–80 minutes, following grounded theory methodology. The interviews were transcribed and analyzed using inductive thematic analysis. Results Professionals in French nursing homes strive to balance patient-oriented, family-oriented, and self-oriented needs when interacting with trusted persons. They prioritize patient care, address family concerns, and ensure their own psychological safety and administrative efficiency, while minimizing litigation risks. However, heterogeneous practices exist in informing families about the trusted person system, leading to awareness gaps and potential conflicts. The evolving work environment in French nursing homes, marked by aging residents and complex legal regulations, exacerbates these challenges. Family conflicts, burdens experienced during the end-of-life phase, and taboos surrounding end-of-life discussions impede collaborative efforts, emphasizing the need for education and improved communication strategies to ensure the effective implementation of trusted person roles. Conclusion Early education is necessary for trusted persons’ effective involvement, as patients’ cognitive impairments and end-of-life anxieties hinder trusted persons’ ability to engage effectively. Involving psychologists or GPs beforehand helps address psychological challenges, facilitating informed discussions before admission.

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“…Plusieurs travaux ont montré une méconnaissance du dispositif aussi bien chez les patients que chez les médecins [1][2][3] même si la situation semble s'améliorer. Une enquête de 2018 révèle que 11% des Français ont rédigé leurs DA et 77% des MG abordent le sujet des DA avec leurs patients surtout s'ils sont âgés ou gravement malades [4].…”

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