[End of life at home: all you need to know]. / Fin de vie au domicile : comment s'y prendre.

Many patients in Switzerland wish to die at home. Nevertheless, end-of-life home care requests specific considerations such as basic palliative care knowledge among health care professionals and a well-organized and coordinated health care network which needs to be put in place as early as possible. Beforehand, an open discussion with the patient and the caregiver about their expectations and wishes is mandatory. Furthermore, anticipation about the evolution of the disease, potential symptoms, material requests, psychological and social barriers is the key element to provide home palliative care until the end of life. Most "cantons from the Romandie" have a large offer in health care services allowing for home end-of-life care.

Une fin de vie à domicile est souhaitée par beaucoup de patients en Suisse, mais sa mise en place nécessite entre autres des connaissances en matière de soins palliatifs et l'organisation précoce d'un réseau de soins interprofessionnel bien organisé et coordonné. Un prérequis est également une discussion ouverte avec le patient et son entourage quant aux attentes et souhaits de soins. L'anticipation par rapport à différents sujets tels que l'évolution de la maladie, les symptômes potentiels, les besoins en matériel, les difficultés psychiques et les problématiques sociales est l'élément clé pour une réussite d'une fin de vie à domicile. Plusieurs cantons romands offrent une large gamme de soins permettant un maintien au domicile jusqu'au décès.

Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study.

BACKGROUND: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. OBJECTIVES: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). METHODS: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. RESULTS: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV1 was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. CONCLUSION: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.

[Advance directives and advance care planning]. / Planification du projet thérapeutique et directives anticipées dans la prise en soins palliative.

Advance directives (AD) and Advance Care Planning (ACP) are two measures a person may undertake to assure that their treatment preferences will be respected until the end of his / her life. Anticipation is based on an open and honest communication between the patient, the durable medical power of attorney and the health care professionals. ADs and ACPs are based on a person's values and beliefs that are important to his quality of life. ACP is a continuing process, initiated by health care professionals and integrated into the health care plan of a person. It should be adjusted all along the disease trajectory and favors communication and anticipation in the health care network. ADs are often a personal initiative to ensure one's wishes in relation to health issues. In Switzerland, they are based on a legal framework and their application is therefore mandatory for health care professionals.

Les directives anticipées (DA) et la planification anticipée du projet thérapeutique (PAPT) permettent d'établir les préférences et souhaits d'une personne en lien avec des soins thérapeutiques. L'élaboration du projet de soins repose sur la communication entre le patient, son proche de confiance et les professionnels de la santé. La qualité de vie et les valeurs de la personne sont les éléments clés de la construction de la PAPT et des DA. La PAPT est un processus qui s'adapte au fur et à mesure de la prise en soins. Elle est relayée et transmise dans un souci de coordination, d'anticipation au fil des épisodes de santé à domicile et / ou en milieu hospitalier. Les DA émanent d'une démarche personnelle le plus souvent et ont une base légale et contractuelle pour les professionnels de la santé.

University hospital center for palliative and supportive care.

The Center for Palliative Care and Supportive Care opened in 2019 with the aim of contributing to the implementation of general palliative care in all departments of the Geneva University Hospitals. Built with the aim of supporting care professionals in the management of patients with palliative trajectories and enhancing their professional skills, depending on their specialisation, the centre has laid out recommendations for the palliative management of people with a life-limiting disease. The results of the centre's actions, carried out in collaboration with these professionals, are encouraging and show a growing use of the recommended tools for the evaluation and management of patients in general palliative care.