Abstract
ABSTRACT Objective: to describe and analyze the challenges and the possibilities of the return to the home in palliative care in the Brazilian and French scenarios. Method: ethnographic study conducted in two hospitals, homes and medical-social establishments. Six people in palliative care, four family members and eight health professionals participated in the study. The data were organized through discursive mapping and analyzed from a cultural and Foucaultian perspective. Results: to present the results, two categories were elaborated: Strategies for hospital discharge in palliative care and between the family, the state and justice: barriers to return home. It is evident that, in Brazil and in France, the return to the home is an event that faces resistance from the families. This fact is mainly related to the cultural conceptions that hospital palliative care units are places capable of providing comfort at the end of life, and difficult access to home care programs and services. In both countries, due to the complexity of hospital discharge, families and managers judicialize this process. Conclusion: the return to the home in palliative care depends on the way death is signified in a culture, the family settings and the existence or not of a network of palliative care in the health systems of each country.
Highlights
The palliative care units are specialized environments for the care of people who present illness with no possibility of modifying treatment, whether they are at the end of life or not
One identifies the social construction of the notion that “good death” or worthy death can be provided by specialized teams that work in these places.[4,5]
Primary Health Care appeared as a strategy that favors the return and permanence of people at home
Summary
The palliative care units are specialized environments for the care of people who present illness with no possibility of modifying treatment, whether they are at the end of life or not. One identifies the social construction of the notion that “good death” or worthy death can be provided by specialized teams that work in these places.[4,5] In this sense, one of the aspects that has mobilized the teams of these units is hospital discharge. For such teams, when the control of signs and symptoms is obtained, the referral to be performed is the return to the home or to establishments that fulfill the social function of shelter, such as long-term care institutions for the elderly or specialized clinics
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