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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 (julie.lamontagne@usherbrooke.ca)
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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

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