Systemic strengths and needs in palliative home care: exploring complexity

Abstract

ObjectiveWe aimed to investigate the relationship between systemic strengths and complexity in home care of end-of-life patients. MethodsQuantitative descriptive longitudinal study of patients cared for at home by a palliative care team. Place of death was analyzed in relation to complexity, as determined by the HexCom complexity model after the initial home assessment. We used Pearson’s chi-square test to analyze the comparison of proportions. ResultsForty-six hundred patients (74.4% oncologic) with a mean age of 76.2 years (SD 13.2) participated. Fifty-three percent had complete or severe functional dependence, 30.8% were already bedridden in the first assessment, and 59.7% died at home. Strengths influenced place of death, specifically exosystem (team) strength (OR: 4.07 [1.92–8.63]), microsystem (both patient 0.51 [0.28−0.94]) and caregiver (OR: 3.90 [1.48–10.25]), and chronosystem, related to prediction of progressive course (OR: 2.22 [1.37–3.60]). ConclusionsTo improve care for end-of-life patients and their families, a systemic view of dying and death that includes both needs and strengths is necessary. In this sense, the systemic framework proposed by Bonfrenbrenner can be useful for clinical practice.