Describing Complexity in Palliative Home Care Through HexCom: A Cross-Sectional, Multicenter Study

Abstract

Background

Complexity has become a core issue in caring for patients with advanced disease and/or at the end-of-life. The Hexagon of Complexity (HexCom) is a complexity assessment model in the process of validation in health-care settings. Our objective is to use the instrument to describe differences in complexity across disease groups in specific home care for advanced disease and/or at the end-of-life patients, both in general and as relates to each domain and subdomain.

Methods

Cross-sectional study of home care was conducted in Catalonia. The instrument includes 6 domains of needs (clinical, psychological/emotional, social/family, spiritual, ethical, and death-related), 4 domains of resources (intrapersonal, interpersonal, transpersonal, and practical), and 3 levels of complexity (High (H), Moderate (M), and Low (L)). Interdisciplinary home care teams assessed and agreed on the level of complexity for each patient.

Results

Forty-three teams participated (74.1% of those invited). A total of 832 patients were assessed, 61.4% of which were cancer patients. Moderate complexity was observed in 385 (47.0%) cases and high complexity in 347 (42.4%). The median complexity score was 51 for cancer patients and 23 for patients with dementia (p<0.001). We observed the highest level of complexity in the social/family domain. Patients/families most frequently used interpersonal resources (80.5%).

Conclusions

This study sheds light on the high-intensity work of support teams, the importance of the social/family domain and planning the place of death, substantial differences in needs and resources across disease groups, and the importance of relationship wellbeing at the end-of-life.

Keywords:

• home care services
• palliative care
• terminally ill
• terminal care
• non-cancer patient
• complexity
• interdisciplinary research

Abbreviations

“Organ failure”, Advanced chronic organ failure; AD/EOL, Advanced disease and/or end-of-life; HexCom, Hexagon of Complexity; PADES, Home care support team program.

Consent for Publication

Not applicable, as the manuscript does not contain personal data.

Data Sharing Statement

While the IDIAP Jordi Gol does not plan on storing anonymous data in a public database, it will provide access to files should reviewers request it.

Ethics and Consent Statement

This study was conducted in accordance with the Declaration of Helsinki. This project was assessed by the Clinical Research Ethics Committee (CEIC) of the IDIAP Jordi Gol. Participating patients gave their informed consent. All participants read and signed an informed consent form.

Acknowledgments

We would like to thank Maria Jesús Micó for her administrative support and Colleen McCarroll for translating and reviewing the English version of this article. We would also like to thank the professionals from the participating PADES teams: Alt-Empordà, Alt-Maresme (Blanes), Bages, Baix-Camp, Baix-Litoral (Sant Boi), Baix-Penedès (Vendrell), Cerdanya, Cornellà, Delta-Hospitalet Sud, El Prat De LLobregat (Delta del Llobregat), Garraf (Vilanova i La Geltrú), Geriàtric (Sabadell), Gironés i Pla de l’Estany, Gràcia, Horta Guinardó, Baix Llobregat-Litoral SAP Delta, Les Corts, Mataró, Martorell, Mollet, Nou Barris, Pallars, Pal·liació Cerdanyola, Palliació Sabadell, Pius Hospital de Valls, Pla d’Urgell-Garrigues, Reus, Ripollès, Sant Cugat, Sant Feliu de Llobregat, Sant Martí Nord, Santa Coloma de Gramenet, Santa Susanna Caldes de Montbui, Segrià Sud de Lleida, Selva Marítima (Blanes), Tarragona, Tarragonès, Tortosa, Badalona-Sant Adrià, Igualada-Anoia, Baix Ebre-Montsià, Dreta Eixample, Sants-Montjuic. We would like to thank the team managers: Anna Serra Plana, Cristina Prat Asensio, Marta Camprubí Rovira, Montse Bonet Martí, J. Cristina Cabrera Bermúdez, Sandra Barceló Castelló, Maica Vallbona González, Lourdes Cortés Bofill, Mercedes Liras García, Marta Sierra García, José M. Cantalejo Moreno, Montserrat López Postigo, Montse Parés Feu, Carme Bassedas Ballús, Angela Cadena Andreu, M. Dolors Martí Colomer, Josep M. Picaza Vilà, Santi Bernades Teixidó, Francesc-Xavier Bosch Petit, Alba Feixa Quer, Priscila Muñoz San Juan, Glòria Rovira Oliva, Ramona González Rubió, Manel Esteban Pérez, Montserrat Bonamaison Tena, Carles Gener Turón, Montse Bonilla Martos, Francisco Cordero Higuero, Alex López Català, Anna Torrents Iglesias, M. Núria Arraràs Torrelles, Jéssica Galán Fernández, Gemma Serra Recasens, Marta Blasco Pastor, Cinta Castellà Valldepérez, Núria Miralles Banqué, Anna Vidal Basalo, Sonsoles Frutos Díaz, Enric Martínez Vieites, Aïna Puig Rodríguez.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, and data analysis and interpretation. They took part in drafting the article and revising its content, approved the final version to be published and agreed to be held accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The IDIAP Jordi Gol funded this project’s databases, and the main researcher (XB) received an internal grant from the Metropolitan Nord Primary Care Service (Catalan Health Institute), the objective of which is to promote research strategies in Primary Care by providing exclusive work packages (60 to 120 hrs) to clinicians to conduct research. This is a public institution that provides logistical and methodological support for research projects without interfering in their design or the collection, analysis and interpretation of data or the drafting of manuscripts.