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The "syndrome de glissement" is a French term used to describe end-of-life situations where the elderly person becomes adynamic and any therapeutic intervention seems ineffective until the patient dies. It is close to failure to thrive. Although its use, which is widespread, seems appropriate to briefly describe a complex situation, it has the major disadvantage of leading to an absence of clinical and therapeutic approach, which represents a loss of chance for the patient. In clinical practice, we consider that what is referred to as a sliding syndrome is actually a situation of apathy associated with a deterioration in general condition. A diagnostic approach should therefore look for all organic pathologies that associate deterioration in general condition and apathy, and neuropsychiatric situations such as episodes of major depression that produce such symptoms. Once these diagnoses have been ruled out, the person should be considered for palliative care and benefit from the expertise that goes with this practice. Any elderly person in a situation resembling what is known as a syndrome de glissement should therefore benefit from a rigorous clinical approach, and not be considered beyond any therapeutic resources. It is a matter of dignity and quality of care.

Competing Interests: Les auteures déclarent n’avoir aucun lien d’intérêts.

Accompanying death is part of the daily life of intensive care workers. However, far from being a trivial experience, it mobilizes the teams emotionally and requires them to constantly adjust in order to carry out their mission of care for the patient and his or her loved ones. How do nurses and orderlies deal with end-of-life care and the particularities of death in an intensive care unit?, (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: End-of-life platelet transfusion practice in onco-hematology is subjective and depends on representations shared by patients, nurses and hematologists. This study aims to describe these representations of platelet transfusion in a context of a severe and advanced hematologic malignancy through the social representation of its protagonists., Methods: A qualitative study, using the associative network method and including three groups of 15 participants (patients with an advanced hematologic malignancy, regularly transfused in platelet concentrates; nurses and hematologic oncologists) from four hematology centers was conducted between February and April 2019. Analysis was carried out using IraMuTeQ software., Results: Patients expect platelet transfusion to have a direct beneficial impact on their health and highlight human relations. Nurses aim at the patient's well-being, in his or her individuality, and at respecting the transfusion protocol. Physicians seek to relieve symptoms by taking into account a multitude of decision-making factors. The textual clustering method, nuances those previous results and individualizes four different orientations, independent of groups: dependency, singularity, subjectivity and neutrality., Discussion: The perception of the social representations related to platelet transfusion at the end-of-life should make it possible to adapt the discourse to the preferred orientation of the speaker and could be an asset in goals of care discussion with patients as well as with teams in charge of palliative care., (Copyright © 2020 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Numerous studies about poor communication and altered quality of life of patients with chronic obstuctive pulmonary disease (COPD) lead to the conclusion that overall palliative management of COPD remains to be improved. The aim of this study was to describe pulmonologists' practice of palliative care for COPD patients in order to identify obstacles to it., Material and Method: A survey was sent to all pulmonologists whose email appeared in the 2017 French-language Respiratory Medicine Society's directory., Results: A total of 294 responses were obtained, among which 287 were analysed. Overall, 81.6% of the pulmonologists said that they identify a distinct palliative phase from "sometimes to often" in the care of COPD patients. When not identified, the most common reason given (68.8%) was the difficulty of defining when to start palliative care. Aspects of the palliative approach, which were considered the most problematic for pulmonologists, were the discussion of end of life care, and the impression that COPD patients have a low demand for information. 31% of pulmonologists reported that they gathered information about patients' wishes to undergo resuscitation and endotracheal intubation in 61 % to 100% of patients who they judged to have the most severe disease., Conclusion: Uncertainty as to when to begin a palliative approach for COPD patients and perceptions around communication in chronic diseases appear to be the main obstacles to a palliative approach., (Copyright © 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The epidemiology of lung cancer is evolving and caregivers need to address an emerging demographic, women, sometimes presenting at a young age. The effect of this ongoing change on thoracic oncology services and on the nursing population (registered nurses and auxiliary nurses) has not been evaluated., Methods: A quantitative analysis can help to control the biases that may have an impact on nursing staff identification with female patients. A categorical and automated qualitative study (Tropes software) of speech productions related to "difficult situations" was carried out., Results: Four contexts activating critical situations were identified: disagreement and conflict in care, a constraining situation of care, an overflow situation, particularly related to increased suffering of the patient and a feeling of being isolated in care delivery. Regarding the management of female patients, after the impact of disagreements in management, the feeling of care being constrained in the presence of a female patient with whom caregivers identify themselves is more significant than with regard to male patients., Conclusion: Support within the care team is essential, but not sufficient. Only a practice-based training context involving peers outside the team seems to help address the most impactful situations., (Copyright © 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Sedation in palliative care meets a precise definition and corresponds to a medical practice. We assessed the comprehension of this practice by the French population., Method: In 2015, citizen expressed their views on the Claeys-Leonetti bill by means of a consultative forum made available on the Internet site of the National Assembly. The content of the messages filed, regarding the right to deep and continuous sedation until death was analyzed using the ALCESTE textual data analysis software, supplemented by a thematic analysis in order to identify the perception that Internet users had of this practice., Results: Among the 1819 Internet users who participated in the forum, 67 expressed their views as Health professionals, 25 of whom were directly involved in palliative care, as well as 10 sick persons. Analysis with the ALCESTE software highlighted two classes of statements. The first dealing with deep and continuous sedation, reflecting the specificity of the discourse of the Internet users. The second one consisted of textual units in which the modal verbs were dominant and overrepresented, thus providing information on the participants' perceptions. The thematic analysis highlighted four themes: death, intent, treatment and fear., Conclusion: Deep and continuous sedation is perceived as a euthanasic practice or raises fear of such a drift. Provision of extended and accurate information to the population and health professionals is essential to ensure that this new model of sedation is integrated into the care of the terminally ill patients and their families., (Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Since the beginning of the 20th century, major technological developments have been made in blood transfusion. Although numerous sociological studies have been conducted on donors, few have highlighted transfused patients, and in this case, the attention has almost exclusively been focused on transfusion risks in patients. Conversely, blood representations associated with the chronically transfused patients have not really been explored in the literature. Based on interviews conducted among chronically transfused patients (patients with hemoglobinopathy, malignant hemopathy or cancer), this present study enables to understand their needs and their expectations through their symbolic representations and their interpretations of blood transfusion, raising tensions as well ethical perspectives., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

For manyyears, a major focus of interest has been the patient, in the context of a constantly changing society and increasingly complex medical practices. We propose to shift this focus on the physician, who is entangled in a similar, but less evident way. In these three articles, we explore, in succession, the lived experience of the contemporary physician, the ethos which brings together the medical community, and the education of the future physician, using research projects currently under way within the Service of Liaison Psychiatry at Lausanne University Hospital. In this first article, we particularly raise the question of what is the lived experience of the physician and sketch the outline of <> research.

This prospective interventional study aims to show the feasibility and impact of information procedure on surrogate and advance directives (AD), for patients with incurable lung or gastrointestinal cancer. The intervention consisted of two semi-structured interviews. The first included: collection of preferences for prognostic information and involvement in decision-making, initial assessment of knowledge, information and surrogate and DA. The second assessed the impact of the first interview on knowledge, surrogate designation and DA writing, the assessment procedure by the patient and assessment of anxiety generated. Among 77 eligible patients, 23 (30 %) were included, 6/29 (21 %) refused to participate, 20/23 (87 %) completed both interviews. Patients not included had a higher 4-month death rate than included ones (39 % vs. 4 %, P=0.002). Patients included had high expectations of information and appreciated it be delivered early, by someone not involved in their care. The study shows the feasibility of the procedure and its impact on the use of surrogate and DA by patients, however, revealing the complexity of approaching end-of-life wills and the importance of a process of anticipated discussion., (Copyright © 2015 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

This article is the result of 700 interviews that have taken place during the past three years in the «Espace Proches» in Lausanne, a place devoted to home caregivers. It attempts to describe the reality of relatives and highlight the specific difficulties they encounter in the different roles they adopt or are given by their surroundings in the face of a progressive disease. It offers suggestions to the physicians of this population at risk on how to better support them in their physical and psychological burden.

The modest impact of specific treatments is a major problem in oncology and particularly for metastatic lung cancer patients. Therapeutic progress achieved by some targeted therapies is, in fact, only relevant for a small proportion of patients. The vast majority of people with this condition are rapidly confronted by the limits of specific therapies and management is or becomes entirely palliative. This article addresses therapeutic limitations in the management of metastatic lung cancer, as well as legislative aspects and guidelines for practitioners when discussing these issues with patients, together with a discussion of the psychological consequences for patients., (Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

The transfer to a palliative care unit requires the acceptance of the patient and their family. Resistance to the transfer can arise and both the patient and their family have to relinquish certain things.

Two major changes in end-of-life management have occured in recent decades: first, because of the increase in life expectancy and the resulting aging of the population, most deaths now involve old or very old people; second, more than two-thirds of deaths occur in a hospital or an institution. Our fellow citizens are afraid of suffering and death. They wish for a peaceful death, as rapid as possible and, in recent surveys, say they favour euthanasia. Yet euthanasia is illegal in France and in most other Western countries (with the exception of the Benelux nations). Palliative care ensures dignity in death, without anxiety of suffering, and is expanding rapidly in France. Léonetti's law of 22 April 2005 ensures the protection of the weakest, who should never be considered unworthy of life, yet is poorly known to the public and even to physicians. It now needs to be applied in practice.

The return home of seriously ill very young children causes worry and upheaval in the family. The home hospital care team supports the child and his/her family enabling links to be forged between them, whatever the outcome of the illness, whilst respecting the rhythm of each family member. The situation of Flora, 14 months, illustrates this support.

Complex and demanding, paediatric palliative care at home is beginning to develop. How can a self-employed nurse, by definition isolated, care for a child approaching the end of life and his/her family at home? What resources and tools does the nurse have to provide this support?

When there is no more hope of a cure during a child's treatment, the curative period makes way for a palliative phase through to the last moments of the child's life. This phase is both difficult and fundamental for the child and his/her family, as well as for the caregivers, who must continue to provide care without any hope of curing the child. This phase determines how the period of mourning which follows the loss of a loved one is experienced, particularly for the family.

In a general paediatric department, nurses may have to care for children suffering from severe life-threatening illnesses. When supporting the child and his/her parents, sometimes until the end of life, they must learn to manage their emotions and adopt a position which is both sympathetic and professional.

Taking care of a child or an adolescent in palliative stage is a testing work for health professionals in paediatric onco-hematology. The communication with the child at the end of life and his family is delicate but however essential to ensure quality cares while supporting trust. The continuation of a genuine relation and a regular information concerning the child's health help the parents to progressively understand the lack of possible cure and the future death of their child. This anticipation also allows to possibly discuss about conditions and place of death of the ill child or adolescent. The child or adolescent himself at the end of life can also feel the need for speaking about his situation. It is then for the adult, parent or health professional, to share with him his questionings and his possible worries in order to reduce his loneliness and his fears. To let be guided by the child allows to respect his progression and his wish to know more about it or not. Finally a support must also be offered for the siblings.

Voice is something which can greatly help healthcare providers because it is a genuine relational tool. Knowing one's voice means finding one's ability to receive, listen, be heard and approach others. Thus, working on one's voice helps to attain self-knowledge which naturally leads to knowledge of others and better quality care for them.

With a chronic illness such as renal failure the individual's psychological state can be turned upside down. In addition to the physical suffering there may be mental suffering which should be cared for through long-term support.

Version 2 of accreditation, known as "certification" by 13 th August 2004 law, introduces assessment practices. The opportunity of introducing these practices, offers to the of introducing these practices, offers to the whole health professional members the possibility of using concretely in their practices, the results and knowledge issued in health taking care research. Registered in a dual approach (research and process quality), the research we have driven aimed to analyze the knowledge, the attitudes and the practices associated to the Léonetti Law Act (Act no 2005-370 from 22nd Apr 2005, in reference with patients' rights and the end of life), towards all kind of health professionals. 1770 of them, working at Toulouse Universitarian Hospital, have answered inquiries which included questions about professional knowledge (confidence person, advanced directives) as well as questions linked with professional practices (attitudes, behaviours, decisions taken ...). The results point out a certain consensus on professional practices: good knowledge about the notion of confidence person, changes in the replies rate about the discriminating variable "seniority", new emerging professional attitudes. This kind of research underlines the deep links between knowledge systems and the attitude requires around palliative care.

The objective of this study was to describe the experience of caring for individuals at the end of life by five nurses working in curative care units. Semi-structured interviews were conducted to gain a better understanding of the meaning nurses give to this experience. The analysis of results, based on Giorgi's phenomenological method (1997), highlighted a central meaning: it is a human experience fraught with paradoxes where the bedside nurse feels both privileged to be accompanying these individuals at the end of their lives and torn between the medical priority given to curative care and the lesser priority given to palliative care. This study offers relevant options for nurse managers wanting to improve these nurses' work environment and the quality of care for individuals at the end of life.