In France, only 30 to 50% of patients who need palliative care actually benefit from it. Although the provision of care has increased, mainly in hospitals, territorial disparities are evident and the provision of home care remains insufficient. In response, Bligny CH, in Briis-sous-Forges (Essonne), opened in February 2024, in collaboration association SPES, a day hospital for early palliative care. In the spotlight this local outpatient care structure, the first in Essonne, responsible for assessing and anticipating patients’ needs and providing support to caregivers.
Founded in early 2024, the Day Hospital (HDJ) for Early Palliative Care in Bligny provides outpatient care for all persons suffering from a serious or progressive illness that requires multidisciplinary assessment and follow-up at all stages of the disease. Care for patients can be one-time or regular, depending on their needs and responds to complex situations, whether medical, psychological or social.
According to the results of an Opinionway survey on the French and home care, published in April 2024, 73% of respondents indicate that they prefer home care at the end of life. Taking into account, among other things, the aging of the population, in the future there will be more sick people to relieve and caregivers to support. Respecting people’s wishes to remain at home involves moving palliative care and end-of-life support away from Palliative Care Units (PCUs), which have insufficient capacity and high costs, and towards the home.
The creation of Bligny palliative care HDJ responds to the need for local, early and gradual care for patients and carers to stay at home as long as possible. ” It is necessary to create palliative care beds to respond to patients who have uncontrolled symptoms and really need to be hospitalized in the USP, but for the rest, in order to respect their choice to be at home, it is necessary to provide a home », points out Jean-Baptiste Méric, medical director and oncologist at Bligny Hospital.
Agathe Delignières, lead psychologist for the hospital’s mobile palliative care team (EMSP), agrees: “HDJ in palliative care are extremely important structures that need to be developed. I’ve seen a lot of hospitalizations of people in the PCU or oncology ward who didn’t necessarily need to be hospitalized. These hospitalizations are expensive and unsatisfactory for patients, families, and care teams. » HDJ prevents patients from being hospitalized in USP due to balancing their analgesic treatment. Monitoring and treatment adjustments can now be done on an outpatient basis.
Better quality of life
Palliative care is little known and often reduced to the very end of life. “Actually, it’s much broader than that, notes Agathe Delignières. I mean neurodegenerative diseases. Although the disease is incurable, care can still be active on the symptoms and the patient can still have many years of life, which can be supported, in palliative care, so that their quality of life is as correct as possible. » dr. Méric Jean-Baptiste Méric emphasizes, for his part, that according to studies, the involvement of the palliative care team in the early phase of care not only increases the comfort and quality of life of patients, but also their life expectancy, as it allows treatments to be carried out better, whether it is about neurodegenerative diseases or oncology. The earlier palliative care is provided, the more it allows predicting needs and preventing crises, improving comfort and quality of life while promoting staying at home. “When the context is safe (strong caregivers, well-constructed circle of care, etc.), we will not necessarily need to hospitalize a patient followed in HDJ,” adds the oncologist.
Parallel, LThe support of loved ones, assessment of the burden on their shoulders, anticipation of their needs and offered solutions for respite are an integral part of HDJ’s mission. “We cannot keep a person at the end of life at home without prior planning. If we don’t have this culture of anticipation and prevention, we either don’t recognize that we’re on the cusp of an acute episode from a medical standpoint for the patient, or we don’t recognize that the caregiver is on the verge of exhaustion and we’re going to have an unplanned hospitalization one weekend.” illustrated by Françoise Ellien, director of the association SAVE and a member of the strategic reflection body responsible for pre-determining the ten-year plan Palliative care, pain management and support at the end of life in France 2024/2034.
“We are monitoring a patient at the end of his life suffering from Parkinson’s disease. During the first consultation, his wife understood after talking with the neurologist and me that she will break down if she doesn’t take care of herself and that staying at home won’t be possible. Since then, while her husband receives wellness care at the day hospital, she takes time for herself,” testified by Dr. Méric. The HDJ team can also support families in their bereavement if they wish.
The patient as a whole
At HDJ, the multidisciplinary team devotes an average of half a day to each consultation, a long time that allows us to gather as much key information as possible from patients and their loved ones in order to establish a personalized care plan with them. “During the first consultation at HDJ, the patient is admitted to his room. We introduce ourselves, ask for news, get to know each other. We take into account everything: sleep, illness, discomfort, interests, consequences of illness on work, psychological, social, spiritual resources, in short, we try to be a little exhaustive. explains Yolaine Bocahu, nurse at Bligny EMSP and holder of the DU for palliative care.
There is no question of reducing a person to his illness, and the latter to therapeutic adjustments, however necessary they may be. Massage, hypnosis, sophrology, relaxation or simply listening, etc., the emphasis in palliative care is on overall patient care. ” Some patients were treated upon arrival, notes Agathe Delignières. We are trying review this: doctors are careful to keep what is important and remove what is not necessarily useful. The supportive care we offer goes in the direction of better patient comfort. They were very well received. » These tools are also completely relevant in the early management of the psychological dimension of patients and their caregivers, either early or in the last moments of life. “In the latter case,” continues Agathe Delignières, ” it can be more complicated. We can easily imagine that a person should be surrounded by people at this very moment, but should he see people who are outside his intimate network? Early care allows you to get to know the person and to be there until the end, that is, to be legitimate in support in the most sensitive moments of life. »
In the end, only the patient’s interest counts. What does he really want? What is his life plan? ” We never know what is good for the patient, he is the one who will tell us, and we adapt as much as possible,” insists Agathe Delignières. Which sometimes leads to therapeutic de-escalation, if that is the person’s wish in the case of, for example, polypathology. “You always have to stick to your goals. Then it’s up to us to mediate between the goals of the doctors who follow him and the patients.”adds Dr. Méric. “ In care palliative, it’s not about not performing an examination, but about conducting tests that are of interest to the patient,” adds Yolaine to Bocah.
Orbi et urbi
The culture specific to palliative care therefore spreads to other departments of Bligny Hospital. “Teams make us from very positive feedback about our interventions, they feel reassured by our presence,” notes Jennifer Kennis, EMSP nurse practitioner. According to Jean-Baptiste Méric, ” Socializing is very important in the dynamics of the establishment. When a new nurse finds herself managing patients for the first time in a ward where there are patients with respiratory failure, it is very anxious. Knowing that the day after her arrival a colleague will offer to teach her two or three things and train her in hypnosis helps build confidence. The teams feel it, and obviously the patients do too.”
The medical staff that HDJ has at its disposal today enables the reception of patients for two half-days a week. Certain expertise and human resources are shared with USP, EMSP and other hospital services. ” We currently have the majority of internal patient referrals already being followed up in our chronic disease departments. The message must be sent to the city and general practitioners,” reports Dr. Méric. The goal is to open 10 half-day appointments per week with an average of 6 patients per day in a few months. And for the record: “ We still see too many cancer patients traveling tens of kilometers for months to receive chemotherapy that they could have received closer to home, with greater involvement of palliative care or health care.” laments the oncologist.