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Master Thesis

La sédation en situation palliative terminale au domicile par le médecin généraliste

Abstract : Leonetti's law has legitimate sedation for palliative care (PC) in terminal situation in case of refractory symptoms or terminal phase distress. This practice happens to be at home through a hospital care at home program (HAD) and palliative care networks (RSP) but also outside those structures, yet without any recent data. Goals: we aim to examine how the sedations practised at home by a general practitioner in terminal palliative care situations comply with the law and with the recommandations of the SFAP (French Society for Support and Palliative care). Material and methods: we have conducted a descriptive practice research based on case study of patients who have received a sedation as part of a terminal palliative treatment at home in 2014 and 2015, in Béarn and Soule. 313 general practitioners have been contacted by phone in order to identify those who have practised a sedation at home during these last two years. The doctors who related were then invited to answer a questionnaire in order to study each case of sedation. Results: 55,3% of the contacted doctors answered the phone call. Among them, 62,4% have practised a sedation at home and 43,3% in 2014 and 2015. We have studied 83 cases of sedation practised by 38 doctors; 35% of these sedations have been given by a general practitioner on his own. We have evidenced that HAD and RSP helped significantly to collect the trustworthy person (document/contact), the end-oflife instructions and improve the collegiality, anticipation of sedation and the use of midazolam. Practitioners trained to palliative care were more likely to call on the RSP than non trained doctors. Nonetheless, the palliative care training didn't seem to influence the practice itself. Conclusion: the general practitioners providing sedation on their own comply with the recommendations but, the access to HAD and RSP improves conformity to the law and make the resort to recommended molecules easier.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01658822
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Submitted on : Thursday, December 7, 2017 - 6:50:07 PM
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Élise Louvet Monory. La sédation en situation palliative terminale au domicile par le médecin généraliste. Médecine humaine et pathologie. 2017. ⟨dumas-01658822⟩

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