End of life conflicts in a palliative care setting: Perceptions of health professionals in French-speaking Valais

Résumé 0

The aim of this study was to identify the perceptions which health professionals in palliative care had of end of life conflicts. The nature of the conflicts, their prevalence, intensity, causes, and effects were specially addressed. Proposals for possible solutions to conflicts were investigated. A cross-sectional study was done through a self-administered questionnaire among 460 health professionals in French-speaking Valais. The health professionals worked either in acute care hospitals, chronic health institutions, and nursing homes, or in ambulatory palliative care units. Among the target population, 233 persons replied to the questionnaire (50.6%). Among the respondents, 82.4% reported confronting end-of-life conflicts. Conflicts were quite rare (66%) and of medium or high intensity (86%). Conflicts were of a medical nature (74%), or related to ethical issues (64%). Conflicts occurred among family members (68%), doctors and nurses (49%), or patients and medical staff (16%). Conflicts were due mainly (50-60%) to lack of communication, ambivalence among parties, and differences in value systems. Many (50-60%) of the consequences of these conflicts involved wasted resources and physical and psychological burn-out. Possible solutions to conflicts include interdisciplinary seminars, internal supervision procedure, and sharing experiences. Age, gender, professional experience, working place, and training were not predictive of exposure to conflicts. End of life conflicts are a common fact. They may compromise quality of care and contribute to high economic and social costs. They should be put on the public health agenda as a high priority.