Hospitalisation à Domicile, Fondation Oeuvre de la Croix Saint-Simon, Paris
A model of a palliative care day centre based on best practice abroad and adapted to local practice in Paris, France
Having worked in France in palliative care for nearly 20 years, in institutions and in the community, I am convinced there is a distinct gap on the present trajectory of palliative care patients who would like to stay at home throughout all or part of their illness. Despite community services, we repeatedly see patients being hospitalised against their will or having to use emergency services where it could have been avoided. Patients often become depressed or withdrawn. We also witness patients and their families bewildered in the frequent disjointed communication between professionals in hospitals and the community. The burden on the families can have a significant negative impact on the quality of their relationship with the ill person, on their capacity to be carers, on their work and on their health and well-being. A realistic answer to help alleviate these and other problems would be the provision of palliative care day centres (PCDC), which don’t exist in France.
The aim of the project is to provide a useable model of a PCDC adapted to the French culture in Paris. The model will be delivered with a well reasoned report illustrating, not only the benefits, but also how PCDCs fit in with national policy to develop palliative care in the community, improve coordination between institutes and the community and encourage innovation in the field of palliative care.
The project will be carried out by the project team in three phases by; executing thorough literature searches, using questionnaires, running focus groups, visiting and interviewing day centres in France and PCDC abroad. Meetings will be set up with the appropriated professionals in order to provide the required expertise for completing the project.
The impact of initiating PCDC in France would be extremely positive for the patient experience, and that of their families. A PCDC would be an interface between institutions and the community and provide increased access to palliative care services. It would help facilitate early detection of symptoms, symptom control and anticipatory prescribing, as well as the opportunity to talk about sensitive matters and advance directives. A PCDC would not only provide family respite, but help to reduce social and psychological problems for the patient like feeling isolated and anxiety. It would also contribute to reducing unplanned hospital admissions, allow reduced hospital stays and the need for emergency services; mobile and hospital based and thus have a positive economical impact.
The model, together with the report, is intended to be the starting block for opening the first of many PCDC in France.