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Systemic strengths and needs in palliative home care: exploring complexity.

X Busquet-Duran1, B Mateu-Carralero2, J Bielsa-Pascual3

  • 1Programa d'Atenció Domiciliària Equip de Suport (PADES), Servei d'Atenció Primària Vallès Oriental, Institut Català de la Salut, Barcelona, Spain; Unitat de Suport a la Recerca Metropolitana Nord (USR-MN), Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Grupo de Investigacion Multidisciplinar en Salud y Sociedad GREMSAS, Barcelona, Spain.

Revista Clinica Espanola
|December 15, 2023
PubMed
Summary

Systemic strengths, including team and caregiver support, significantly influence where end-of-life patients die at home. A systemic approach is vital for improving palliative home care.

Keywords:
ComplejidadComplexityCuidados paliativosEvaluación de necesidadesHome care servicesLugar de muerteNeeds assessmentPalliative carePlace on deathServicios de atención de salud a domicilio

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Area of Science:

  • Palliative Care
  • Gerontology
  • Sociology

Background:

  • Home care for end-of-life patients presents complex challenges.
  • Understanding factors influencing place of death is crucial for quality palliative care.

Purpose of the Study:

  • To investigate the relationship between systemic strengths and the complexity of end-of-life home care.
  • To determine how different systemic levels (exosystem, microsystem, chronosystem) impact patient outcomes.

Main Methods:

  • Quantitative descriptive longitudinal study involving 4600 home care patients.
  • Complexity assessed using the HexCom model; place of death analyzed.
  • Pearson's chi-square test used for statistical analysis.

Main Results:

  • 59.7% of patients died at home; 53% had severe functional dependence.
  • Exosystem (team) strength (OR: 4.07) and caregiver strength (OR: 3.90) positively influenced home death.
  • Patient (microsystem) strength (OR: 0.51) and chronosystem (OR: 2.22) also showed significant associations.

Conclusions:

  • A systemic perspective, considering patient and caregiver strengths, is essential for effective end-of-life home care.
  • Bronfenbrenner's systemic framework can guide clinical practice in palliative care.
  • Identifying and leveraging systemic strengths can improve care and support for dying patients at home.