Decision about Cancers in Complex Medical and Social Situations: The 'Reunions de concertation pluridisciplinaires medicoso dales et ethiques (RCP MSE)' Organised in Saint-Louis Hospital

摘要

Within the scheme of access to healthcare for destitute people, regulated by the French law of July 29 1998, the PASS {permanence d'acces aux soins de sante) Verlaine in Saint-Louis hospital sees many patients with high social instability, without financial social coverage, or strangers with linguistic barrier, without stable housing, social or familial environment, often penniless and with severe diseases such as advanced cancer or end-stage renal failure. It became obvious to the doctors responsible of the PASS that a strictly medical standardized proposal such as palliative chemotherapy could not by itself represent a useful solution, considering the multiple vulnerabilities of these patients. The "Reunions de concertation pluridisciplinaires medicosocuiles ci ethiques (RCP MSE)" organised in Saint-Louis hospital put together the referring doctor, various specialists according to considered pathology, doctor(s) from the PASS itself, nursing staff, social workers, the coordinator of cancer care in the hospital, representatives of administration and service users. These meetings allow to consider and take into account, in order to establish the care program, all the vulnerabilities and constraints, to which are submitted the patient as well as the healthcare system, in order to make a proposal as adequate as possible in these highly complex situations