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Master Thesis

Interdisciplinarité dans la prise en charge d’un patient en situation de fin de vie à domicile par le biais d’un protocole dans une Maison de Santé Pluridisciplinaire du Lot-et Garonne : ressentis et vécus des professionnels

Abstract : Introduction: today, 85% of French people wish to be accompanied at home when they near end of life, but in fact only 24% died there according to INSEE in 2018, showing a discrepancy between what people wish and the reality. Interdisciplinary work is popular as part of a global approach, as there is a need for inter-professional coordination in order to create a specific care path. The question of creating an interdisciplinary multi-professional protocol arises. Research question: what is the feeling and experience of professionals from a multidisciplinary team working in interdisciplinarity through a protocol of care for a patient nearing death at home? The objective is to assess their feelings and experience of interdisciplinarity as part of a protocolization of end-of-life care at home. Method: qualitative study with professionals working in the same health area contributing to the care of life-ending patient at home. A theorisation is suggested after performing various samplings, individual interviews, full transcription and then a double coding until data saturation is obtained. Results: 15 structured interviews were held between February and December 2020 to obtain the saturation of the data. We find a favorable perception of protocolization, by creating a secured framework in favor of a patient-centered approach. This protocolization would allow to strengthen interdisciplinarity by prioritizing communication and defining key care contributors. Some limits are found, starting with a strong emotional climate in palliative care that can lead to relationship issues. Then, we define a particular worrying aspect: the patient and his/her entourage, who will be evolving in a particularly stressful environment, the home. In addition, doubts are expressed as to the rigidity of a protocol, which could be dangerous. There is a recognition of a lack of knowledge that can lead to fear and a negative perception of the care. We also notice a lack of inter-professional links due to a lack of availability and organization. Nevertheless, the future seems conceivable and positive in a Multidisciplinary Healthcare House by working together with a positive team spirit and well-built interprofessional links that can be defined by a protocol and an effective communication (with regular meetings, debriefing, common tools). Conclusion: interdisciplinary work is perceived as profitable with a bright future by the different professionals. There is recognition of a beneficial but complex exercise, especially with concerns about availability, organization and communications. We can be in favor of a protocolization which would not be too strict, but which would facilitate the care. This work emphasizes the need for interdisciplinarity in home care and highlights the sensitivity of using a protocol. This work is a prerequisite for the development of an interdisciplinary multi-professional management protocol.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03333663
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Submitted on : Friday, September 3, 2021 - 10:28:30 AM
Last modification on : Saturday, October 16, 2021 - 3:22:23 AM
Long-term archiving on: : Saturday, December 4, 2021 - 6:43:07 PM

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Jérôme Poline. Interdisciplinarité dans la prise en charge d’un patient en situation de fin de vie à domicile par le biais d’un protocole dans une Maison de Santé Pluridisciplinaire du Lot-et Garonne : ressentis et vécus des professionnels. Médecine humaine et pathologie. 2021. ⟨dumas-03333663⟩

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