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Hématologie

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Patient demise: palliative care, an answer to physicians' distress Volume 7, issue 1, Janvier - Février 2001

Authors
GRASPH, service d'hématologie, CHRU Bretonneau, 37044 Tours cedex 1. 2

Correct management of terminally ill patients and their families requires taking into account, in a satisfactory manner, not only the patient's physical symptoms but also the psychological, social and spiritual distress of both patients and their families. While the answer to physical symptoms is of course strictly medical, the answer to other kinds of distress means high quality accompaniment which in turn means time, availibility and empathy. We think that, in regard to palliative care, the next challenge will be to develop internal structures in each care unit that would enable medical and paramedical professionnals to give high quality accompaniment cannot be insured by someone who is himself or herself in some degree of distress. Having analysed the different phases, the effects on the patient - physician relationship and the causes of professionnal exhaustion, we will review in detail the different solutions that could be considered in individual care units and, on a more general scale in hospital institutions, to help alleviate distress when faced with patient death. In individual care units, internal palliative care training facilitates other solutions. But these can only be materialized by a palliative care project specific to the care unit and by the possibility of discussing individual case histories and finally, if so desired, the creation of discussion groups. All this means external help (and positive action by the institution) necessary to improve the quality of managing both patients and their families: - palliative care specialists; - psychologists for both patients and families; - volunteer workers with time to listen to patients and their families. These external elements must play a precise and limited role so as not to create tension in the medical team.