{"id":1780,"date":"2004-10-01T01:00:00","date_gmt":"2004-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/attitude-des-hepatogastroenterologues-des-hopitaux-generaux-face-au-probleme-de-la-prise-en-charge-des-malades-en-fin-de-vie\/"},"modified":"2018-10-20T18:39:34","modified_gmt":"2018-10-20T16:39:34","slug":"attitude-des-hepatogastroenterologues-des-hopitaux-generaux-face-au-probleme-de-la-prise-en-charge-des-malades-en-fin-de-vie","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/attitude-des-hepatogastroenterologues-des-hopitaux-generaux-face-au-probleme-de-la-prise-en-charge-des-malades-en-fin-de-vie\/","title":{"rendered":"ATTITUDE DES H\u00e9PATOGASTROENT\u00e9ROLOGUES DES H\u00f4PITAUX G\u00e9N\u00e9RAUX FACE AU PROBL\u00e8ME DE LA PRISE EN CHARGE DES MALADES EN FIN DE VIE."},"content":{"rendered":"

2004<\/strong><\/p>\n

Denis LABAYLE, B\u00e9n\u00e9dicte LAMBARE, Benjamin WISNIEWSKI
\n Centre Hospitalier Sud francilien EVRY<\/em><\/p>\n

Vie Professionnelle <\/strong>– \u00a02004-09-14 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction. Plusieurs affaires judiciaires r\u00e9centes ont pos\u00e9 le probl\u00e8me de la prise en charge des patients en fin de vie, et de l\u2019euthanasie en particulier. Pour la loi actuelle, toute prescription m\u00e9dicamenteuse susceptible d\u2019abr\u00e9ger la vie du patient est consid\u00e9r\u00e9e comme criminelle et sanctionn\u00e9e comme telle. Le but de cette enqu\u00eate a \u00e9t\u00e9 d\u2019approcher la r\u00e9alit\u00e9 de la pratique m\u00e9dicale hospitali\u00e8re face aux probl\u00e8mes pos\u00e9s lors de la fin de la vie des patients et de la comparer \u00e0 la l\u00e9gislation en cours.
\nM\u00e9thodes. L\u2019enqu\u00eate a \u00e9t\u00e9 r\u00e9alis\u00e9e au cours de la r\u00e9union scientifique annuelle de l\u2019Association Nationale des Gastro-ent\u00e9rologues des H\u00f4pitaux g\u00e9n\u00e9raux (ANGH) qui s\u2019est tenue les 12 et 13 septembre 2003. Un questionnaire anonyme a \u00e9t\u00e9 remis \u00e0 l\u2019ouverture du congr\u00e8s \u00e0 chaque participant, en lui demandant d\u2019y r\u00e9pondre individuellement, sur place, et de le remettre \u00e0 la fin de la journ\u00e9e. Ce questionnaire portait sur plusieurs points : l\u2019organisation structurelle des services pour la prise en charge des patients en fin de vie : existence de r\u00e9unions d\u2019\u00e9quipe sp\u00e9cifiques, possibilit\u00e9 de faire appel \u00e0 une \u00e9quipe mobile ou \u00e0 un centre de soins palliatifs ; les habitudes th\u00e9rapeutiques : traitement de la douleur, drogues utilis\u00e9es, posologies maximales prescrites ; la relation avec le patient et leur famille sur les risques th\u00e9rapeutiques encourus ; la connaissance par les m\u00e9decins de la l\u00e9gislation actuelle sur l\u2019euthanasie en France et \u00e0 l\u2019\u00e9tranger.
\nR\u00e9sultats. Sur 85 participants, 56 m\u00e9decins, repr\u00e9sentant une cinquantaine de services d\u2019h\u00e9pato-gastroent\u00e9rologie r\u00e9partis sur l\u2019ensemble du territoire, ont r\u00e9pondu \u00e0 l\u2019\u00e9tude. Sur les 56 m\u00e9decins interrog\u00e9s, 17 (30%) participent dans leur service \u00e0 des r\u00e9unions sp\u00e9cifiques pour discuter de l\u2019attitude \u00e0 adopter pour les patients en fin de vie ; 47 (84 %) ont la possibilit\u00e9 de faire appel \u00e0 une \u00e9quipe mobile de soins palliatifs, 27 (48 %) adressent \u00e9ventuellement leurs patients dans une unit\u00e9 de soins palliatifs dont seulement 4% de fa\u00e7on r\u00e9guli\u00e8re. 7 (13%) s\u2019y refusent par principe et 19 (34%) n\u2019en ont pas la possibilit\u00e9.
\nEn ce qui concerne les attitudes th\u00e9rapeutiques, on note que 100% des m\u00e9decins hospitaliers interrog\u00e9s utilisent la morphine et ses d\u00e9riv\u00e9s pour traiter la douleur. Dix (18%) limitent la posologie jusqu\u2019\u00e0 une dose risquant d\u2019entra\u00eener des troubles respiratoires, 46 (82%) l\u2019augmentent jusqu\u2019\u00e0 ce que le malade ne souffre plus quels qu\u2019en soient les risques vitaux. La tr\u00e8s grande majorit\u00e9 d\u2019entre eux, 49 (87,5 %) prescrit des associations de morphine et de s\u00e9datifs (benzodiaz\u00e9pines pour 68 % dont le midazolam [hypnovel] dans 38%). Les malades sont pr\u00e9venus des risques encourus trois fois sur quatre pour la morphine, une fois sur deux avec les tranquillisants. Une demande \u00e9ventuelle des malades et des familles pour traiter la souffrance quels que soient les risques encourus est signal\u00e9e par 50% et 94 % des praticiens, respectivement. Quatre m\u00e9decins sur cinq ignorent le texte de loi sur l\u2019euthanasie. Dix-huit % estiment que la loi n\u2019est pas respect\u00e9e mais ne doit pas \u00eatre chang\u00e9e, 22% qu\u2019elle n\u2019est pas respect\u00e9e et doit \u00eatre revue. Les autres ne se prononcent pas.
\nEn conclusion, en France, dans les services hospitaliers d\u2019h\u00e9pato-gastroent\u00e9rologie o\u00f9 les m\u00e9decins sont souvent confront\u00e9s au probl\u00e8me de la fin de vie des patients, la prise en charge de la douleur est une pr\u00e9occupation r\u00e9elle. La lutte contre la souffrance est consid\u00e9r\u00e9e par la grande majorit\u00e9 des m\u00e9decins comme prioritaire, et ils n\u2019h\u00e9sitent pas \u00e0 augmenter les posologies de morphine et des benzodiaz\u00e9pines quels que soient les risques vitaux. L\u2019emploi fr\u00e9quent du midazolam (hypnovel), produit utilis\u00e9 en anesth\u00e9sie, atteste de cette volont\u00e9. Ces r\u00e9sultats prouvent le d\u00e9calage majeur existant entre la r\u00e9alit\u00e9 des pratiques m\u00e9dicales et la l\u00e9gislation actuelle.<\/p>\n","protected":false},"excerpt":{"rendered":"

2004 Denis LABAYLE, B\u00e9n\u00e9dicte LAMBARE, Benjamin WISNIEWSKI Centre Hospitalier Sud francilien EVRY Vie Professionnelle – \u00a02004-09-14 –\u00a0CO – ________________________________ Introduction. Plusieurs affaires judiciaires r\u00e9centes ont pos\u00e9 le probl\u00e8me de la prise en charge des patients en fin de vie, et de l\u2019euthanasie en particulier. Pour la loi actuelle, toute prescription m\u00e9dicamenteuse susceptible d\u2019abr\u00e9ger la vie […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[5],"tags":[15],"class_list":["post-1780","post","type-post","status-publish","format-standard","hentry","category-professionnel","tag-15"],"yoast_head":"\nATTITUDE DES H\u00e9PATOGASTROENT\u00e9ROLOGUES DES H\u00f4PITAUX G\u00e9N\u00e9RAUX FACE AU PROBL\u00e8ME DE LA PRISE EN CHARGE DES MALADES EN FIN DE VIE. - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/attitude-des-hepatogastroenterologues-des-hopitaux-generaux-face-au-probleme-de-la-prise-en-charge-des-malades-en-fin-de-vie\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ATTITUDE DES H\u00e9PATOGASTROENT\u00e9ROLOGUES DES H\u00f4PITAUX G\u00e9N\u00e9RAUX FACE AU PROBL\u00e8ME DE LA PRISE EN CHARGE DES MALADES EN FIN DE VIE. - 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