Plus-value des soins palliatifs à domicile pour les patients souffrant de cancers : une revue de littérature

Abstract

En Afrique Subsaharienne, 80 à 90 % des patients atteints de cancers, arrivent à l’hôpital au stade de l’incurabilité de la maladie. Dans la quasi-totalité de ces moments, nombreux sont les patients dépourvus de moyens financiers, qui préfèrent rester à leur domicile pour y recevoir les soins palliatifs ou pour y mourir faute d’autres alternatives. Ce qui confronte les professionnels de la santé à un ensemble d’enjeux et de défis lorsqu’ils s’invitent aux soins palliatifs à domicile. La question qui demeure est de savoir si cette approche de soins abordée sur le prisme du modèle de la complexité, est en tous points efficace sur le plan clinique et économique. Pour y répondre, une revue narrative de la littérature a été réalisée de 2008 à 2020 sur les bases de données de Hinari. Elle a abouti à une sélection de 53 articles clés publiés en français et en anglais. Il ressort des résultats de la recherche, que sans être un idéal de soins, les soins palliatifs à domicile permettent : d’améliorer la qualité de vie des patients et des familles, de réduire le fardeau des symptômes et les coûts des soins comparativement aux soins habituels.

Practice of Palliative Care at Home in Central Africa: Reflection and Lessons

“…Home-based palliative care is defined as a comprehensive set of care provided at home to a patient suffering from a life-limiting illness and to their family [9]. The desire for this type of care originates from the observation that, in Central Africa, the suffering of patients is poorly taken into account in a good number of current programs for the treatment of chronic diseases, particularly those developed in countries with low income [1]. It is becoming urgent to carry out advocacy to make politicians and decision-makers listen to reason so that where palliative care at home does not exist, it can be instituted.…”

“…Research findings show that palliative home care improves patient survival time and mood. They reduce hospital visits and patient travel time [1]. For these authors, this care reduces the duration of hospitalizations and the cost of medical care for patients with malignant neoplasms.…”

“…It is perhaps for this reason that it is uncommon in Africa in general and relatively new in Central Africa [1]. In this part of the continent, palliative care at home is not recognized as a medical specialty, and it is not integrated into the diploma training of health personnel [1]. Waelli and Minvielle [28] add the lack of government support.…”

“…In these countries, very little legislation governs the implementation of palliative care at home, as can be seen elsewhere. As a result, care pathways and appropriate symptom management interventions are underestimated or obsolete [1]. Linked to the person, one of the obstacles to the development of palliative care at home is the fear that the patient experiences, particularly with regard to the unfavorable opinion of his relatives and the ineffectiveness of the care he will receive at home compared to hospital care.…”

“…Palliative home care is a comprehensive package of care provided to patients and their families at home [1]. They include pain control and symptom management, psychosocial and spiritual care, and support with activities of daily living [2].…”