Fortalezas sistémicas y necesidades en atención paliativa domiciliaria: explorando la complejidad

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola Pub Date : 2024-01-01 DOI:10.1016/j.rce.2023.11.004

X. Busquet-Duran , B.M. Carralero , J. Bielsa-Pascual , L. Milian-Adriazola , N. Salamero-Tura , P. Torán-Monserrat

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引用次数: 0

Abstract

Objective

We aimed to investigate the relationship between systemic strengths and complexity in home care of end-of-life patients.

Methods

Quantitative 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.

Results

Forty-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]).

Conclusions

To 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.

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居家姑息关怀的系统优势和需求：探索复杂性

方法对姑息治疗团队在家护理的患者进行定量描述性纵向研究。研究分析了死亡地点与复杂性的关系，复杂性是在初次家庭评估后根据 HexCom 复杂性模型确定的。我们使用皮尔逊卡方检验来分析比例比较。53%的患者有完全或严重的功能依赖，30.8%的患者在首次评估时已卧床不起，59.7%的患者死于家中。优势会影响死亡地点，特别是外在系统（团队）优势（OR：4.07 [1.92-8.63]）、微观系统（患者 0.51 [0.28-0.94]）和照护者（OR：3.90 [1.48-10.25]），以及与预测进展过程相关的时间系统（OR：2.22 [1.37-3.60]）。从这个意义上讲，Bonfrenbrenner 提出的系统框架对临床实践很有帮助。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista clinica espanola 医学-医学：内科

CiteScore

4.40

自引率

6.90%

发文量

审稿时长

28 days

期刊介绍： Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI). The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Nine issues are published each year, including mostly originals, reviews and consensus documents.