Program 1 : Palliative and supportive care

Program 1 : Palliative and supportive care


FOSSEY-DIAZ - Virginie- web

Dr Virginie FOSSEY-DIAZ is geriatrician, head of geriatrics and adult palliative care since 2015 at Bretonneau Hospital. She is co-pilot of UCOG Paris Nord with Prof. Culine since 2012. Multi-site UCOG, consultation and advices at bedside and during MDT meetings are deployed on the 6 adult hospitals of our Institute.

Anne Blazy


Audrey lebel

Dr Audrey LEBEL, MD is working at AP-HP for more than 12 years and is currently the Head of the mobile team of palliative care (EMASP) at Saint-Louis Hospital. After internship and residency at AP-HP Hospitals,  she graduated as a medical oncologist at Paris 6 “Pierre et Marie Curie” Université, and she hold a palliative care specialty diploma (DESC) while being assistant professor (Chef de Clinique) at Henri Mondor AP-HP University Hospital. She also hold a Master of applied philosophy and medical ethics, and a Master of Ethics at Paris-Saclay University.


Elisabeth vernin

Elisabeth VERNIN
Anne Bouchardy

P1 - Palliative and Support Care


Cancer Care

  • Good representation across all hospital sites
  • Well-identified patient pathways
  • Palliative care unit (full hospitalization) at Bretonneau hospital; mobile supportive and palliative care teams (EMASP = Equipe Mobile d’Accompagnement et de Soins Palliatifs) and dedicated beds for palliative care within clinical departments (Lits Identifiés Soins Palliatifs) in all other hospitals of the Cancer Institute AP-HP Nord.
  • Admission for palliative care:
  • Bretonneau hospital:CORPALIF (Coordination Régionale des Soins Palliatifs en Ile de France) requests, telephone agreement between doctors, home hospitalization. Downstream care consists in arranging home hospitalization or admitting patients into rehabilitation services.Bichat/Beaujon/Saint-Louis/Lariboisière hospitals:Coordinating nurse or any other professional (physician, nurse, psychologist, manager, social worker, care assistant) using specific forms, Orbis tool (electronic patient record), or spontaneous request of the patient or his/her family by telephone/email. 
  • Admission for pain management:
  • Saint-Louis hospital:– Medical request from Saint-Louis Hospital doctors: specific internal request- Medical request from other hospitals, clinics, rehabilitation services, home hospitalization, palliative care, with a formal letter or telephone agreement between doctors- Request from private doctors with a formal letter- Waiting time until the first appointment at the Institute: <15 days for an external consultation, <48 hours for an internal consultation. 

    Beaujon/Bichat hospitals, pain department:

    – Patients are seen at the request of physicians from the Bichat Hospital

    – Hospitalized patients (day hospital or traditional hospitalization): advice from the floor care unit, at the patient’s bedside

    – Non-hospitalized patients: pain consultation


  • Admission for other supportive care:
  • – Educational social workers and psychologists are available at the request of patients and/or their family. For other professionals, a medical prescription or referral by a health professional is necessary (physiotherapist, dietician, speech therapist).- In the context of the announcement of a cancer therapeutic plan for a new patient, the paramedical consultation (coordinating nurse or electroradiology manipulator) includes information on the availability of supportive care and a systematic screening of the patient’s needs in order to anticipate situations.- Different complementary activities are set up depending on the site (adapted physical activities, care and beauty workshops, adapted sport, discussion groups, etc.).- At the Saint-Louis site, a health information center was created to offer patients and their families a place to talk, be listened, and receive information outside of care. Information on all supportive care is given there.


  • Basic science: Centre de recherche en épidémiologie et santé des populations U1018


  • Participation in training for the University Diploma (DU) “Pain in oncology” (IGR), DU “Digestive oncology” (Saint-Louis Hospital)
  • Participation in the Pain and cancer commission of the French society for the study and treatment of pain (SFETD=Société française d’étude et traitement de la douleur)
    • Elaboration of a practical guide to start and develop the placement of intrathecal catheters with implantable pumps in refractory cancer pain
    • Elaboration of a continuing education program on cancer pain (Nov. 2021)
    • Participation in the « Cancer pain day » (2019) on the theme “PCA in oncology”
    • Moderation of the « Resisting pain in oncology » session, SFETD congress, 2017
    • Moderation of the cancer session, SFETD congress 2020: « Update on interventional radiology and pain »
  • Internal training at each hospital site of the Institute: pain and palliative care for doctors (internal, external) and for nurses (registered nurses/assistant nurses), and continuing education days
  • Initial training:
    • « Listening and helping relationship » (2 sessions /4h, Saint-Louis hospital), for assistant nurses
    • « Palliative care » (2x 4h, nurse training institutes (IFSI) of Saint-Louis and Saint-Anne Hospitals
    • « Ethics and decision/palliative care » for 2nd-cycle medical students (2x 2h), Université Paris Cité
  • Training for Master classes: « Ethics and advanced practice nurses » (in the 1styear of the program for all students and in the 2nd year for the oncology and hematology Master students), “Pain” (in the 2nd year, advanced practice nurses, oncology and hematology module).
  • Training for paramedical professionals:




  • Training for assistant nurses by coordinating nurses:
    • Saint-Louis Hospital: 1 day on pain assessment 4 times per year + 1 day on PCA/TENS 4 times per year
    • Nurse training institute (IFSI) Saint-Louis: “Pain training »
    • « Short pain management » training in hospital departments
    • « Short and long training for management of intravenous devices (DIVLD and PICC line) » for Saint-Louis Hospital assistant nurses and for the nurse training institute (IFSI)
    • Management of intravenous catheters for pain, nurse training institutes Saint-Louis and Saint-Anne Hospitals (Paris)
  • Continuing education AP-HP Picpus:
    • « Organizing the return home of sick adults requiring palliative care: medical and care project » (25 people – medical and paramedical professionals – 7 hours/day, twice a year)
    • Bichat hospital: 2 hours, « Palliative care structures and their articulations (LISP, USP, EMASP) » / 4 hours: supporting patients with serious and/or chronic diseases (twice a year)
    • « Limitation of treatment discontinuation in intensive care » (1 day)
  • « Analysis of professional practices »: 5h30
  • Local CLUD-SP: (Comité de LUtte contre la Douleur et pour le développement des Soins Palliatifs): Hospital committee for pain management, three to four meetings per year at local CLUDs
  • Central hospital committee for pain management AP-HP CLUD-SP: 4 times per year, and office meetings every 2 months