Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-25T19:22:37.279Z Has data issue: false hasContentIssue false
  • English
  • Français

Le choix de traitement en triade incluant un patient âgé apte en soins palliatifs : à la recherche d’un modèle théorique

Published online by Cambridge University Press:  15 March 2011

Julie Lamontagne ,
Marie Beaulieu  and
Marcel Arcand
Julie Lamontagne*
Affiliation:
Université de Sherbrooke
Marie Beaulieu
Affiliation:
Université de Sherbrooke
Marcel Arcand
Affiliation:
Université de Sherbrooke
*
*La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Julie Lamontagne, M.A., Ph.D. (c), Université de Sherbrooke, Centre de recherche sur le vieillissement- Centre de santé et de services sociaux-Institut, Universitaire de Gériatrie de Sherbrooke (CSSS-IUGS), 1036, Belvédère sud, Sherbrooke, Québec J1H 4C4 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

The elderly in palliative care are confronted with difficult decisions relating to treatments. The philosophy of palliative care, namely, including the patient and his/her family right away, leads the doctor to consult with the two parties involved when choosing a treatment. As no theoretical model allows us to understand how the decision-making process hinges on the trio (a capable elderly person, a family caregiver, and the doctor) in a context of palliative care, we propose one which was developed from three strategies of document analysis: theoretical synthesis, theoretical analysis, and theoretical derivation. According to our model, the decision-making process depends on individual factors influencing the decision of the participant, expectations and attitudes as to the role, the level of confidence amongst the parties involved, the manner in which they communicate with each other, their mutual understanding of the clinical and ethical issues, and, finally, their ability to cooperate.

Résumé

Les aînés en soins palliatifs sont confrontés à des décisions difficiles liées aux traitements. La philosophie des soins palliatifs, incluant d’emblée le patient et sa famille, amène le médecin à travailler en concertation avec ces deux acteurs lors du choix thérapeutique. Puisqu’aucun modèle théorique ne permet de comprendre comment s’articule le processus décisionnel en triade (patient apte à consentir aux soins, proche aidant et médecin) dans un contexte de soins palliatifs, nous en proposons un, développé à partir de trois stratégies d’analyse des écrits : la synthèse théorique, l’analyse théorique et la dérivation théorique. Selon notre modèle, le processus décisionnel dépend des facteurs individuels influençant la décision du participant, des attentes et attitudes face au rôle, du niveau de confiance entre les acteurs, de la façon dont ils communiquent entre eux, de leur compréhension mutuelle des enjeux cliniques et éthiques et finalement de leur capacité de collaboration.

Keywords

decision-making process for treatmentcapable elderly personclosest caregiverdoctorpalliative carecare-givng triadprise de décision de traitementpersonne âgée apteproche aidantmédecinsoins palliatifstriade de soins
Type
Regular Articles / Articles réguliers
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 30 , Issue 1 , March 2011 , pp. 127 - 142
Copyright
Copyright © Canadian Association on Gerontology 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Références

Abbott, K.H., Sago, J.G., Breen, C.M., Abernethy, A.P., & Tulsky, J.A. (2001). Families looking back: One year after discussion of withdrawal or withholding of life-sustaining support. Critical Care Medicine, 29(1), 197–201.CrossRefGoogle ScholarPubMed
Adelman, R.D., Greene, M.G., & Ory, M.G. (2000). Communication between older patients and their physician. Clinics in Geriatric Medicine, 16(1), 1–24.CrossRefGoogle Scholar
Albrecht, T.L., Ruckdeschel, J.C., Riddle, D.L., Blanchard, C.G., Penner, L.A., Coovert, M.D., et al. . (2003). Communication and consumer decision making about cancer clinical trials. Patient Education and Counseling, 50(1), 39–42.CrossRefGoogle ScholarPubMed
Arcand, M. (2007). Soins de fin de vie. Dans Arcand, M., & Hébert, R. (Eds.), Précis pratique de Gériatrie (3rd ed., pp. 1233–1252). Canada: Edisem inc.Google Scholar
Arora, N.K., & McHorney, C.A. (2000). Patient preferences for medical decision making. Who really wants to participate? Medical Care, 38(3), 335–341.CrossRefGoogle ScholarPubMed
Beauchamp, T.L., & Childress, J.F. (2008). Principles of biomedical ethics (6th ed.). New York: Oxford University Press.Google Scholar
Bégin, L. (1995). L’éthique par consensus. Dans Parizeau, M.-H. (Ed.), Hôpital & Éthique (pp. 176–189). Saint-Nicolas, Québec, Canada: Les Presses de l’Université Laval.Google Scholar
Boire-Lavigne, A.-M. (2005). Un modèle complexe de la prise de décision en soins en fin de vie. Dans Allard, J., et Arcand, M. (Eds.), Enjeux et controverses dans les soins aux personnes âgées en grande perte d’autonomie: Actes des échanges cliniques et scientifiques sur le vieillissement (pp. 202–219). Sherbrooke, Québec, Canada: Centre d’expertise en santé de Sherbrooke.Google Scholar
Breen, C.M., Abernethy, A.P., Abbott, K.H., & Tulsky, J.A. (2001). Conflict associated with decisions to limit life-sustaining treatment in intensive care units. Journal of General Internal Medicine, 16(5), 283–289.CrossRefGoogle ScholarPubMed
Brueckner, T., Schumacher, M., & Schneider, N. (2009). Palliative care for older people - exploring the views of doctors and nurses from different fields in Germany. BMC Palliative Care, 8(7), 1–27.CrossRefGoogle ScholarPubMed
Bruera, E., Neumann, C.M., Mazzocato, C., Stiefel, F., & Sala, R. (2000). Attitudes and beliefs of palliative care physicians regarding communication with terminally ill cancer patients. Palliative Medicine, 14(4), 287–298.CrossRefGoogle ScholarPubMed
Bruera, E., Sweeney, C., Calder, K., Palmer, L., & Benisch-Tolley, S. (2001). Patient preferences versus physician perceptions of treatment decisions in cancer care. Journal of Clinical Oncology, 19(11), 2883–2885.CrossRefGoogle ScholarPubMed
Bruera, E., Willey, J.S., Palmer, J.L., & Rosales, M. (2002). Treatment decisions for breast carcinoma. Patient preferences and physician perceptions. Cancer, 94(7), 2076–2080.CrossRefGoogle ScholarPubMed
Butow, P.N., Dowsett, S., Hagerty, R.G., & Tattersall, M.H. (2001). Communicating prognosis to patients with metastatic disease: what do they really want to know? Supportive Care in Cancer, 10(2), 161–168.CrossRefGoogle ScholarPubMed
Caron, C.D., Griffith, J., & Arcand, M. (2005). End-of-life decision making in dementia. The perspective of family caregivers. Dementia, 4(1), 113–136.CrossRefGoogle Scholar
Carroll, J., & Johnson, E. (1990). Decision research: A field guide. London: Sage.Google Scholar
Cartwright, C. (2000). End-of-life decision making: Practical and ethical issues for health professionals. Australasian Journal on Ageing, 19(2), 57–61.CrossRefGoogle Scholar
Center on an Aging Society. (2005). Adult Children. The likelihood of providing care for an older parent. Data Profiles: Center on an Aging Society, 2, 1–5. Récupéré le 15 octobre, 2005 de http://www.aging-society.org.Google Scholar
Chambers-Evans, J., & Carnevale, F.A. (2005). Dawning of awareness: The experience of surrogate decision making at the end of life. The Journal of Clinical Ethics, 16(1), 28–45.CrossRefGoogle ScholarPubMed
Champoux, N., Lebel, P., & Gosselin, L. (2005). Les personnes âgées et leurs proches. Dans Richard, C., et Lussier, M.-T. (Eds.), La communication professionnelle en santé (pp. 387–399). Saint-Laurent, Québec, Canada: Édition du Renouveau Pédagogique inc.Google Scholar
Choi, Y.S., & Billings, J.A. (2002). Changing perspectives on palliative care. Oncology, 16(4), 515–522.Google ScholarPubMed
Chouliara, Z., Kearney, D., Molassiotis, A., & Miller, M. (2004a). Perceptions of older people with cancer of information, decision making and treatment: A systematic review of selected literature. Annals of Oncology, 15(11), 1596–1602.CrossRefGoogle ScholarPubMed
Chouliara, Z., Miller, M., Stott, D., Molassiotis, A., Twelves, C., & Kearney, N. (2004b). Older people with cancer: Perceptions and feelings about information, decision-making and treatment-a pilot study. European Journal of Oncology Nursing, 8(3), 257–261.CrossRefGoogle ScholarPubMed
Coward, H., & Sidhu, T. (2000). Bioethic for clinicians: 19. Hinduism and Sikhism. Canadian Medical Association Journal, 163(9), 1169.Google Scholar
Dalton, J.M. (2003). Development and testing of the theory of collaborative decision-making in nursing practice for triads. Journal of Advanced Nursing, 41(1), 22–33.CrossRefGoogle ScholarPubMed
Degner, L.F., Kristjanson, L.J., Bowman, D., Sloan, D., Carriere, K.C., O’Neil, J., et al. . (1997). Information needs and decisional preferences in women with breast cancer. The Journal of American Medical Association, 277(18), 1485–1492.CrossRefGoogle ScholarPubMed
Drought, T.S., & Koening, B.A. (2002). “Choice” in end-of-life decision making: Researching fact or fiction? The Gerontologist, 42(3), 114–128.CrossRefGoogle ScholarPubMed
Durand, G. (1999). Introduction à la bioéthique. Histoire, concepts et outils. Canada: Fides.Google Scholar
Ellerby, J.H., McKenzie, J., McKay, S., Gariépy, G.J., & Kaufert, J.M. (2000). Bioethics for clinicians: 18. Aboriginal culture. Canadian Medical Association Journal, 163(7), 846.Google Scholar
Evers, M.M., Meier, D.E., & Morrison, R.S. (2002). Assessing differences in care needs and service utilisation in geriatric palliative care patients. Journal of Pain and Symptom Management, 23(5), 424–432.CrossRefGoogle ScholarPubMed
Ferris, F.D., Balfour, H.M., Bowen, K., Farley, J., Hardwick, M., Lamontagne, C., et al. . (2002). Modèle de guide des soins palliatifs: fondé sur les principes et normes de pratique nationaux. Ottawa, Ontario, Canada: Association canadienne de soins palliatifs (ACSP).Google Scholar
Fisher, R., Ross, M.M., & MacLean, M.J. (2000). Un guide des soins en fin de vie aux aînés. Ottawa, Ontario, Canada: Santé Canada.Google Scholar
Ford, S., Fallowfield, L., & Lewis, S. (1996). Doctor-Patient interactions in oncology. Social Science & Medicine, 42(11), 1511–1519.CrossRefGoogle ScholarPubMed
Friedrichsen, M.J., Stang, P.M., & Calsson, M.E. (2000). Breaking bad news in the transition from curative to palliative care—patient’s view of the doctor giving the information. Supportive Care in Cancer, 8(6), 472–478.Google ScholarPubMed
Gaston, C.M., & Mitchell, G. (2005). Information giving and decision-making in patients with advanced cancer: A systematic review. Social Science & Medicine, 61(10), 2252–2264.CrossRefGoogle ScholarPubMed
Greene, M.G., & Adelman, R.D. (2003). Physician-older patient communication about cancer. Patient Education and Counseling, 50(1), 55–60.CrossRefGoogle ScholarPubMed
Greipp, M.E. (1996). The hospice choice: Ethical decision making. The American Journal of Hospice & Palliative Care, 13(5), 28–34.CrossRefGoogle ScholarPubMed
Hagerty, R.G., Butow, P.N., Ellis, P.M., Dimitry, S., & Tattersall, M.H.N. (2005). Communicating prognosis in cancer care: A systematic review of the literature. Annals of Oncology, 16(7), 1005–1053.CrossRefGoogle Scholar
Hebert, R.S., Schulz, R., Copeland, V.C., & Arnold, R.M. (2009). Pilot testing of a question prompt sheet to encourage family caregivers of cancer patients and physicians to discuss end-of-life issues. The American Journal of Hospice and Palliative Care, 26(1), 24–32.CrossRefGoogle ScholarPubMed
Kapo, J., Morrison, L.J., & Liao, S. (2007). Palliative care for the older adult. Journal of Palliative Medicine, 10(1), 185–209.CrossRefGoogle ScholarPubMed
Koedoot, C.G., de Haan, R.J., Stiggelbout, A.M., Stalmeier, P.F.M., de Graaff, A., Bakker, P.J.M., et al. . (2003). Palliative chemotherapy or best supportive care? A prospective study explaining patients’ treatment preference and choice. British Journal of Cancer, 89(12), 2219–2226.CrossRefGoogle ScholarPubMed
Lambert, P., & Lecomte, M. (2000). Le citoyen: une personne du début à la fin de sa vie: État de la situation des soins palliatifs au Québec. Québec: Association québécoise de soins palliatifs.Google Scholar
Levine, M., & Whelan, T. (2001). Decision-making process–-communication risk/benefits: Is there an ideal technique? Journal of the National Cancer Institute. Monographs, 30, 143–145.CrossRefGoogle Scholar
Long, D., & Robert, A.-M. (1996). L’évaluation en psychogériatrie de l’aptitude à gérer ses biens, à prendre soin de sa personne et à consentir aux soins. Revue québécoise de psychologie, 17(2), 45–69.Google Scholar
Macmillan, K., Peden, J., Hopkinson, J., & Hycha, D. (2004). Guide des aidants naturels. Un manuel de soins en fin de vie. Ottawa, Québec, Canada: L’ordre militaire et hospitalier de Saint-Lazare de Jérusalem et L’Association de soins palliatifs.Google Scholar
McWilliam, C.L., Belle Brown, J., & Stewart, M. (2000). Breast cancer patients’ experiences of patient-doctor communication: A working relationship. Patient Education and Counseling, 39(2–3), 191–204.CrossRefGoogle ScholarPubMed
Miller, D.L., & Bolla, L.R. (1998). Patient values. The guide to medical decision making. Clinics in Geriatric Medicine, 14(4), 813–829.CrossRefGoogle ScholarPubMed
Ministère de la Santé et des Services sociaux du Québec. (2004). Politique en soins palliatifs de fin de vie. Québec, Canada: La direction des communications du ministère de la Santé et des Services sociaux.Google Scholar
Pasman, H.R.W., Mei The, B.A., Onwuteaka-Philipsen, B.D., Ribbe, M.W., & van der Wal, G. (2004). Participants in the decision making on artificial nutrition and hydration to demented nursing home patients: A qualitative study. Journal of Aging Studies, 18(3), 321–335.CrossRefGoogle Scholar
Quill, T.E., & McCann, R. (2003). Decision making for cognitively impaired. Dans Morrison, R.S., & , Meier, D.E. (Eds.), Geriatric palliative care (pp. 332–341). Oxford, UK: Oxford University Press.Google Scholar
Richard, C., Lussier, M.-T., & Kurtz, S. (2005). Une présentation de l’approche Calgary-Cambridge. Dans Richard, C., & Lussier, M.-T. (Eds.), La communication professionnelle en santé (pp. 291–324). Saint Laurent, Québec, Canada: Édition du Renouveau Pédagogique inc.Google Scholar
Ross, M.M., MacLean, M.J., Cain, R., Sellick, S., & Fisher, R. (2002). End of life care: The experience of senior and informal caregivers. Canadian Journal on Aging/La Revue canadienne du vieillissement, 21(1), 137–146.CrossRefGoogle Scholar
Rothenbacher, D., Lutz, M.P., & Porzsolt, F. (1997). Treatment decisions in palliative cancer care: Patients’ preferences for involvement and doctors’ knowledge about it. European Journal of Cancer, 33(8), 1184–1189.CrossRefGoogle Scholar
Ryan, J., & Sysko, J. (2007). The contingency of patient preferences for involvement in health decision making. Health Care Management Review, 32(1), 30–36.CrossRefGoogle ScholarPubMed
Saint-Arnaud, J. (1999). Les traitements en fin de vie. Dans Saint-Arnaud, J. (Ed.), Enjeux éthiques et technologies biomédicales (pp. 61–90). Montréal, Québec, Canada: Presse de l’Université de Montréal.CrossRefGoogle Scholar
Saint-Arnaud, J. (2001). L’approche par principes comme cadre conceptuel pour l’analyse des problèmes d’éthique liés à l’utilisation des techniques de prolongation de la vie. Ethica Clinical, 24(1), 45–51.Google Scholar
Sapir, R., Catane, R., Kaufman, B., Isacson, R., Segal, A., Wein, S., et al. . (2000). Cancer patient expectations of and communication with oncologists and oncology nurses: The experience of an integrated oncology and palliative care service. Supportive Care in Cancer, 8(6), 458–463.CrossRefGoogle ScholarPubMed
Savard, N. (1995). Le consensus: Clarifications apportées par la psychologie sociale. Dans Parizeau, M.-H. (Ed.), Hôpital & Éthique (pp. 190–198). Saint-Nicolas, Québec, Canada: Les Presses de l’Université Laval.Google Scholar
Sepucha, K.R., Belkora, J.K., Tripathy, D., & Esserman, L.J. (2000). Building bridges between physicians and patients: Results of a pilot study examining new tools for collaborative decision making in breast cancer. Journal of Clinical Oncology, 18(6), 1230–1238.CrossRefGoogle ScholarPubMed
Statistique Canada. (2004). Principales causes de décès, Canada, 2005, hommes et femmes confondus. Récupéré le janvier 6, 2009 sur le site de l’Agence de santé publique du Canada, http://www.phac-aspc.gc.ca/publicat/lcd-pcd97/table1-fra.phpGoogle Scholar
Statistique Canada. (2006). Estimations des décès, selon le sexe et le groupe d’âge, Canada, provinces et territoires, annuel (personnes). Récupéré le 4 janvier, 2009 sur le site CANSIM, http://www5.statcan.gc.ca/cansim/home-accueil?lang=fra.Google Scholar
Steinhauser, K.E., Clipp, E.C., McNeilly, M., Christakis, N.A., McIntyre, L.M., & Tulsky, J.A. (2000). In search of a good death: Observations of patients, families and providers. Annals of Internal Medicine, 132(10), 825–832.CrossRefGoogle ScholarPubMed
Sze, J., Marisette, S., Williams, D., Nyhof-Young, J., Crooks, D., Husain, A., et al. . (2006). Decision making in palliative radiation therapy: Reframing hope in caregivers and patients with brain metastases. Supportive Care in Cancer, 14(10), 1055–1063.CrossRefGoogle ScholarPubMed
Tilden, V.P., Tolle, S.W., Nelson, C.A., & Fields, J. (2001). Family decision-making to withdraw life-sustaining treatments from hospitalized patients. Nursing Research, 50(2), 105–115.CrossRefGoogle ScholarPubMed
Tulsky, J.A., Fischer, G.S., Rose, M.R., & Arnold, R.M. (1998). Opening the black box. How do physicians communicate about advance directives? Annals of Internal Medicine, 129(5), 441–449.CrossRefGoogle ScholarPubMed
Verhaak, C.M., Kraaimaat, F.W., Staps, A.C.J., & van Daal, W.A.J. (2000). Informed consent in palliative radiotherapy: Participation of patients and proxies in treatment decision. Patient Education and Counseling, 41(1), 63–71.CrossRefGoogle Scholar
Vohra, J.U., Brazil, K., Hanna, S., & Abelson, J. (2004). Family perceptions of end-of-life care in long-term care facilities. Journal of Palliative Care, 20(4), 297–302.CrossRefGoogle ScholarPubMed
Walker, L.O., & Avant, K.C. (2005). Strategies for theory construction in nursing (4th Ed.). USA: Pearson/Prentice Hall.Google Scholar
Way, J., Back, A.L., & Curtis, J.R. (2002). Withdrawing life support and resolution of conflict with families. British Medical Journal, 325(7376), 1342–1345.CrossRefGoogle ScholarPubMed