Abstract
Capturing complexity is both a conceptual and a practical challenge in palliative care. The HexCom model has proved to be an instrument with strong reliability and to be valid for describing the needs and strengths of patients in home care. In order to explore whether it is also perceived to be helpful in enhancing coordinated and patient-centred care at a practical level, a methodological study was carried out to assess the face validity of the model. In particular, a Delphi method involving a group of 14 experts representing the full spectrum of healthcare professionals involved in palliative care was carried out. The results show that there is a high level of agreement, with a content validity index-item greater than 0.92 both with regard to the complexity model and the HexCom-Red, HexCom-Basic, and the HexCom-Clin instruments, and higher than 0.85 regarding the HexCom-Figure and the HexCom-Patient instruments. This consensus confirms that the HexCom model and the different instruments that are derived from it are valued as useful tools for a broad range of healthcare professional in coordinately capturing complexity in healthcare practice.
Highlights
Due to the inclusion of all groups of pathologies within the scope of palliative care [1,2] and the incessant aging of the population [3], substantial growth is expected in the demand for these healthcare services in the upcoming years [4]
Drawing on Bronfenbrenner’s ecological systems theory, Pask et al [11] offer an innovative framework for understanding complexity by emphasizing the natural ecological environment of the individual, which is formed by the set of relationship structures that accommodate him/her
It can be argued that this high degree of consensus is associated with the systemic approach [11] underlying the HexCom model, which allows the detection of unmet needs and understands complexity as a multidimensional construction, and a multireferential construction, taking into account the training of the diverse healthcare teams involved in complexity assessment [34]
Summary
Due to the inclusion of all groups of pathologies within the scope of palliative care [1,2] and the incessant aging of the population [3], substantial growth is expected in the demand for these healthcare services in the upcoming years [4]. In the Spanish context, it is considered that 1.5% of the population and 11% of people over 65 need palliative care [5,6,7]. This progressive and quantitative increase brings along a sophistication of this demand. The very nature of “complexity” is controversial [12] This is partly due to the fact that it emerges from the concurrence of multiple interrelated factors, whether they are clinical, contextual, or related with the health system [13]. In an attempt to enhance the concept’s applicability and endorse a patient-centred clinical practice, a number of systemic theoretical frameworks have been developed and adopted over the last few years in the field of palliative care. Drawing on Bronfenbrenner’s ecological systems theory, Pask et al [11] offer an innovative framework for understanding complexity by emphasizing the natural ecological environment of the individual, which is formed by the set of relationship structures that accommodate him/her
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