Qu'est-ce qu'une unité de soins « performante », du point de vue des malades relevant de soins palliatifs et de leurs proches ?

In a context of scarce resources, rationalizing health care has become essential, including providing end-of-life care. Following a period in which hospitals had encouraged the creation of palliative care units (PCUs) and palliative care support teams (PCSTs), now all units confronted with dying patients are being asked to adopt a “palliative approach”, that is, to change significantly their way of dealing with end-of-life patients. Yet, what constitutes “good” palliative care? How can the “efficiency” of different units be measured? Do they all provide patients and their families with the same quality of service? The objective of this research was to identify the qualities or “attributes” that these units must possess to be considered by the patients and their families as “effective”. This was a qualitative study, conducted between September 2005 and May 2006 in five PCUs, in which we used semi-directive interviews with 25 patients and 25 families. Discourse analysis allowed us to highlight the aspects of care most important for the persons interviewed, in terms of both the health care team (as a whole and according to different personnel categories within the team) as well as the environment in which this care is provided (in the patients' rooms or in public areas). In an economic context that is inherently unfavourable to developing PCUs, the efficiency of different health teams providing end-of-life care should be considered in the light of all these attributes.