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Enhancing End-of-Life Care: French Government Unveils Seven-Step Strategy

A few months back, President Emmanuel Macron of France revealed during an interview with two newspapers the plan to introduce a bill concerning assisted dying to the parliament in May.

In the interview with La Croix and Libération newspapers, Macron specified that only adults with full mental capacity, enduring an untreatable and life-threatening illness in the near to medium term, and experiencing unmanageable pain would be eligible to “request assistance in dying.”

The government was scheduled to present the bill to the Council of Ministers on Wednesday. Undoubtedly, there exist strong and divergent opinions within the medical community on this matter.

Simultaneously, and with less controversy, the government will unveil its decade-long strategy for providing end-of-life patients with supportive care nationwide.

The primary objective of the supportive care strategy is to enhance access to palliative care in France. The allocated budget is expected to increase to €2.7 billion annually throughout the program’s duration.

Outlined below are the key components of the strategy:

Establishment of Palliative Care Units in all départements

Presently, approximately 20 départements in France lack palliative care units (unité de soins palliatifs), including Ardennes, Meuse, Haute-Marne, Vosges, Haute-Saône, Jura, Orne, Eure-et-Loir, Mayenne, Sarthe, Cher, Indre, Creuse, Lozère, Lot, Tarn-et-Garonne, Gers, Pyrénées-Orientales, Mayotte, and French Guiana.

The government’s plan involves inaugurating dedicated units with 10 beds for the care of end-of-life patients for a specified period. By 2024, 11 of these underserved départements will have operational units, with the remaining nine to follow suit by 2025.

In addition to specialized services, the strategy includes enhancing palliative care offerings in curative services where “designated palliative care beds” are already in place, particularly in oncology units.

Establishment of Units for Pediatric Patients

The Ministry of Health aims to establish pediatric palliative care units (unités de soins palliatifs pédiatriques – USPP), with two units expected to commence operations by year-end to cater to terminally ill children, whose requirements differ from those of adults. The government plans to establish a total of 17 units, covering all regions, by 2030.

Furthermore, the government intends to augment the number of regional teams that share their palliative expertise with all caregivers dealing with children in need of palliative care. These resource teams are set to increase from 23 to 28 within the next decade.

Enhanced Palliative Care at Home and in Care Facilities

Currently, the bulk of expenditure on palliative care is linked to hospital stays, which can be expensive and not always the most suitable option for patients, as per the government’s assessment. To facilitate a transition towards home-based care, the government plans to create 100 “mobile palliative care teams” by 2034, each typically comprising a doctor, two nurses, and a psychologist, surpassing a total of 500 teams.

These teams will provide support to community-based healthcare professionals, aiding patients in returning home and remaining there. Concurrently, a system of specialized on-call teams will be established to offer guidance and assistance to attending physicians round the clock.

The government also intends to bolster home hospitalization services under its proposed initiatives, with the number of patients expected to rise from 70,000 to 120,000 within a decade. Additionally, plans are in place to recruit an extra 6,000 personnel, including psychologists, to enhance end-of-life care in care facilities.

Establishment of Support Homes Nationwide

For patients who are unable to stay at home but do not necessitate hospitalization, a network of “support homes” will be developed across France to cater to individuals who are either unwilling or unable to remain in their homes.

The initial eight support homes are slated to open in 2025, with a goal for each département to have one by 2034.

Implementation of Personalized Support Plans

The government aims to advocate for “supportive care” rather than solely focusing on palliative care. The objective is to “anticipate patient care from the point of diagnosis” and extend it to encompass all medical and non-medical requirements, along with providing support to the patient’s family and friends.

Starting in 2025, about 50,000 patients will receive a “personalized plan” following their diagnosis. Patients will actively participate in tailoring the plan to their specific needs, as outlined in the proposed legislation.

Support for Families

France has approximately 11 million family members serving as caregivers. The bill proposes dedicated consultations for both patients and their caregivers at the time of diagnosis.

The government pledges to simplify caregivers’ access to caregiver leave through the daily support allowance within five years, introduce respite solutions, and enhance psychological support services.

Professional Training and Education

Recognizing the critical need for additional personnel to support its palliative care initiatives, the government plans to create about 20 senior clinician, academic, and assistant positions annually from 2024 to educate and train individuals in what essentially constitutes an emerging university program in palliative medicine.

A specialized module focusing on supportive care will be integrated into student training programs, and a “diploma of specialized studies in palliative medicine and supportive care” will be established, elevating palliative care to the level of cardiology, pneumology, or neurology. Continuous education initiatives will be expanded, and three medical research teams will be recruited to advance knowledge in this domain.