«Pourquoi la médecine palliative devrait(devra)-elle être une spécialité?» «Rencontre avec les experts européens» LYON le 10 Avril 2015

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1 «Pourquoi la médecine palliative devrait(devra)-elle être une spécialité?» «Rencontre avec les experts européens» LYON le 10 Avril 2015 Benoît BURUCOA CHU Université - Bordeaux

2 PLAN Introduction : a context I- Basis, specificities and complexity II- Maturity but limits Conclusion

3 European Association for Palliative Care (EAPC) 1993, recommendations for the initial training of the doctors in this discipline Updated: - In 2007 for the pre-graduate education - In 2009 for the post-graduate education Three levels: basic, intermediate and specialized

4 Recent official texts : for example OMS 2013, 91, p European Council Resolution 1649, 2014

5 Palliative medicine : A medical specialty in 18 European countries EAPC Task Force on the Process of Specialisation in Palliative Medicine in Europe 8th EAPC World Research Congress in Lerida (Spain) Dr Carlos Centeno and coll., University of Navarra Institute for Culture and Society (ICS) ATLANTES Research Programme, Pamplona, Spain Posted on July 21, 2014 by pallcare

6 Supplement to the EAPC Atlas for PC in EUROPE : Specialisation in Palliative Medicine for Physicians in Europe out of 53 European countries have official specialisation programmes: the Czech Republic, Denmark, Finland, France, Georgia, Germany, Hungary, Ireland, Israel, Italy, Latvia, Malta, Norway, Poland, Portugal, Romania, Slovakia and the United Kingdom. Ten of these programmes have been started in the last five years, demonstrating that palliative medicine is truly growing as a field of specialisation in Europe.

7 PLAN Introduction I- Basis, specificities and complexity II- Maturity but limits Conclusion

8 Emergences of concepts Strengths, targets Humanism et pragmatism C. Saunders (1967) Concepts : - Total pain - Personnalisation and subjectivity - Inter-disciplinarity, interprofessionalism - Care, Continuum Care - Global approach, participative approach - Transversality 50 Years! 3. Saunders C, Baines M, Dunlop R. La vie aidant la mort. Paris : Arnette ; 1993.

9 PC Specificities and large theoretical fields Clinics, Therapeutics Relation, communication Organization Ethics Education Legal Economics 4. Kubbler Ross E. Les derniers instants de la vie. Genève : Labor et Fides ; Years 5. Jacquemin D. Manuel de soins palliatifs Ed. Dunod 2014.

10 Dissemination of practices «Step by step!» Not simple transfer of knowledges But transformation of the practices and the organizations Change of relations and partnership Decision-making evolution Thus New speciality! 8. Mino JC, Frattini MO. Les soins palliatifs en France : «mettre en pratique» une politique de santé. Revue Française aise des Affaires Sociales 2007 ; 2 :

11 Waiting for Re-evolution : Loans and Synthesis Fragility Resistance Complexity Recognition (need of ) Deepening and adjustment (need of ) Thus necessary specialization

12 PLAN Introduction I- Basis, specificities and complexity II- Maturity but limits Conclusion

13 French plans of PC development 122 PCU (USP) 418 Mobile teams (EMSP) + 75 réseaux Triple mission: care, education and research Increasing number of structures 800 practicians in palliative specific structures Generaly full time Exclusive practice

14 Maturity versus specialization 1. Care and treatments A lot of clinical and therapeutic data Clinical aspects ot terminal phasis Assessment and treatment of symptoms Early palliative care 10. Jacquemin D. Manuel des Soins Palliatifs. Centre d'éthique médicale - Dunod ed. ; 2001 ; 776 p. 11. Recommandations ANAES : «Modalités de prise en charge de l adulte nécessitant des soins palliatifs». 12/03/ Stafford B, Good P. Inpatient palliative medicine is evidence based. Palliative Medicine, 2001 ;15 (6)

15 2. Relation-Support Psychological studies Proximology Laws: rights and duties Ethics New fields to explore, to invent, to found 14. Conférence de consensus ANAES : «Accompagnement de la personne en fin de vie et de ses proches». 01/01/ Loi n du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé. 16. Loi n du 22 avril 2005 relative aux droits des malades et à la fin de vie.

16 3. Education Hypertrophy of techno-scientist Little share left with the teaching of the PC Also in psychology and ethics But DU-DIU, Master Structural and organizational Education stake for PC 17. Mallet D., Aubry R. Rapport 2007 du comité national de suivi du développement des soins palliatifs. 18. Ambroise-Thomas P, Aurengo A et al. Organisation des études de Médecine, Pharmacie, Odontologie et Maïeutique1 dans le cadre du système européen LMD (Licence-Master-Doctorat). Communiqué de l'académie Nationale de Médecine. 2006

17 In The DESC! Médecine de la douleur, Médecine M palliative - Appointment of 7 associated professors In The LMD-Bologne-opportunity! the LMD! Prefiguration of speciality? 19. Arrêté du 26 janvier

18 DES-Project : YES? Graduate of specialized studies : To give a quality training to the doctors of the PC structures To exercise an expertise To contribute to the development of researches (lethal diseases, palliative medicine and end of life) In complex situations In transversality Medical Speciality : will be, may be?? CNEFUSP and associate professors

19 4. Research To support methodically To structure To finance To connect with research centers 20. Kaasa S, Radbruch L. Palliative care research priorities and the way forward. European Journal of Cancer, 2008 ; Mar Burucoa B, Hermet R, Sentilhes-Monkam A et al. La recherche en soins palliatifs : approches et méthodes. Paris ; SFAP 2004 : 120 pages

20 Fragilities of PC LIMITS of Competencies Experiences Development of structures Acculturation AND SO : Good practices really?

21 Conclusion 1 Speciality A base and a springboard! Transversality Coherence Creativity 22. Grynszpan D, Lellouch. Exercice médical en soins palliatifs : spécificité et place dans la médecine contemporaine : 162 p. 23. Mallet D. Quels paradoxes des soins palliatifs dans le système de santé. Ethica Clinica 1999 ; 16 : 19-25

22 Conclusion 2 To become there, For the future Tissue of interstitial support between areas of medical specialization 24. Pandelé S. La grande vulnérabilité : Fin de vie- Personnes âgées- Handicap. Paris, Seli Arslan ; 2008 : 126 p

23 Conclusion 3 PROCESS : Rail of the thought 1- Protest, emergence 2- Practices and places 3- Specific teachings 4- Research early stages 5- Recognition NOW! SPECIALIZATION GO ON! GROW UP! WE CAN TOGETHER! THE END, Thank you very much!

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