Les besoins des parents confrontés aux soins palliatifs et au décès de leur enfant - étude exploratoire

Cartography of Factors Influencing Caregivers' Experiences of Loss: A Promising Tool to Help Social Workers Support Caregivers

This article introduces a cartography tool to help social workers work with and support family caregivers. This tool aims to determine (1) which caregivers are likely to need additional support during bereavement and (2) what resources the caregiver has that care teams can rely on for decision-making and planning. The purpose of this article is to present a preliminary assessment of the cartography based on the feedback collected from potential users regarding the tool's content and usage.

[Neonatal palliative care at home: Contribution of the regional pediatric palliative care team]

The "patients' rights and end-of-life care" act, known as the Leonetti law, has allowed implementation of palliative care in neonatology as an alternative to unreasonable therapeutic interventions. A palliative care project can be offered to newborns suffering from intractable diseases. It must be focused on the newborn's quality of life and comfort and on family support. Palliative care for newborns can be provided in the delivery room, in the neonatal unit, and also at home. Going home is possible but requires medical support. Here we describe the potential benefits of the intervention of a regional team of pediatric palliative care for newborns, both in the hospital and at home. Two clinical situations of palliative care at home started in the neonatal period and the neonatal unit are presented. They are completed by a retrospective national survey focusing on the type of support to newborns in palliative care in 2014, which was conducted in 22 French regional pediatric palliative care teams. It shows that 26 newborns benefited from this support at home in 2014. Sixteen infants were born after a pregnancy with a palliative care birth plan and ten entered palliative care after a decision to limit life-sustaining treatments. Twelve of them returned home before the 20th day of life. Sixteen infants died, six of them at home. The regional pediatric palliative care team first receives in-hospital interventions: providing support for ethical reflection in the development of the infant's life project, meeting with the child and its family, helping organize the care pathway to return home. When the child is at home, the regional pediatric palliative care team can support the caregiver involved, provide home visits to continue the clinical monitoring of the infant, and accompany the family. The follow-up of the bereavement and the analysis of the practices with caregivers are also part of its tasks.

La famille face à l’enfant gravement malade : le point de vue du psychologue

La maladie grave atteint profondément et douloureusement l’enfant qui en souffre, mais aussi l’ensemble de sa famille. Celle-ci se retrouve précipitée dans une crise émotionnelle aiguë déclenchée par la menace de perdre l’enfant ainsi que par la remise en question des fantasmes d’immortalité de l’enfant et de l’ensemble des membres de sa famille. Cette situation induit des vécus et des sentiments variés (recherche de sens, sentiment d’échec, angoisse, agressivité, sentiment d’impuissance, de culpabilité, etc.) qui auront un impact inévitable sur l’enfant, sa famille et les relations aux soignants.

Notre expérience de plus de 15 ans en pédiatrie aiguë nous a appris que si la capacité à faire face à la maladie grave de l’enfant varie selon des facteurs personnels (la personnalité, l’âge de l’enfant, le tempérament de chacun), elle dépend aussi du couple parental et du système familial dans ses aspects d’adaptabilité, de communication, de cohésion et de développement.

En passant par la retranscription du discours de quelques familles, nous abordons quelques réactions parentales et familiales face à l’enfant gravement malade, en s’attardant sur certaines situations complexes (bébé malformé, enfant de parents séparés, besoins des parents dont l’enfant est en soins palliatifs) et sur quelques pistes de réflexion autour de leur accompagnement. Nous terminerons en évoquant brièvement la question du deuil et de son suivi.