Professionals’ perspectives on trusted persons in French nursing homes

Abstract

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.