Representation of End of Life for oncologist and palliative care practitioners ; Représentations de la fin de vie pour les oncologues et les praticiens de soins palliatifs

International audience ; ContextIn Western countries, the care of patients at the end of their lives is guaranteed by law. Unlike death, the notion of “end of life”, though it is mentioned in some laws, has no legal nor medical definition and should guarantee adapted care for patients. Is the notion of end of life a consensual concept to delineate the boundary between curative care and refusal of unreasonable obstinacy? Our main hypothesis was that in oncology, the end of active drugs (antineoplastic) defined the start of the “end of life”.MethodologyThis was a prospective, multicentre, qualitative study, conducted through semi-directed interviews with oncologists and physicians working in palliative care units. The COREQ report guideline has been used.ResultsThe end of life could not be defined unanimously, and corresponded to two concepts framing the discontinuation of active drugs. The “objective” end of life was reaching a medical consensus while the “subjective” end of life, which is subject to multiple representations, was directly impacting the medical behaviour related to the cessation of active drugs.ConclusionDeath is experienced as a reality with a subjective component. The discontinuation of active therapies initiates discussions about medical possibilities for end-of-life management. The doctor then shifts from his function of “knowing” to confront himself with the expression of a patient's autonomy and the needs of the entourage. ; ContexteDans les pays occidentaux, les soins des patients en fin de vie sont encadrés par la loi, mais à la différence de la mort, la « fin de vie », évoquée dans l’intitulé des lois, n’a pas de définition légale ni médicale. La notion de fin de vie est-elle un concept consensuel permettant de délimiter la frontière entre le soin curatif et le refus d’une obstination déraisonnable ? Notre hypothèse principale était qu’en oncologie, l’arrêt des thérapeutiques actives (antinéoplasiques) définissait le début de la fin de vie.MéthodologieIl s’agissait d’une étude qualitative ...