Transformations of palliative care in French hospitals. A survey in palliative care units, supportive teams and curative care services

Objectives - Disseminating the "palliative approach'' to all hospital services which have to deal with the end-of-life is a major feature of the development of palliative care in France. The aims of this article are to examine the ways in which palliative care, increasingly integrated into hospital's activity, are configured in French hospitals. Methods. - The data was collected through individual semi-structured interviews with 64 caregivers and volunteers working in three distinct organizational frameworks: palliative care units, palliative care supportive teams and curative care services. Results. - The principal results highlight a diversity of working configurations, reflecting the heterogeneity of the palliative care world (as concerns both its conceptions and practices of end-of-life care), and show that the debates which run through the palliative care teams tend not only to persist, but also to become more acute, as this activity unfolds in an open environment. Conclusion. - If it is possible to act on certain factors to improve the dissemination of the "palliative approach'' in hospital services (such as by training health care providers or by reorganizing the services), two other frequently underestimated factors tend to discourage changes in practice: the limited time in which the staff has to perform multiple tasks and the actual capacity of each professional "to care for the dying''. (C) 2013 Elsevier Masson SAS. All rights reserved.