Factors associated with therapeutic complexity at the end of life: Analysis of a cohort of patients undergoing palliative care at home

Complexity at the end of life is the result of the interrelationship of all the patients needs at this stage. The Hexagon of Complexity (HexCom) enables a multi-dimensional approach to patients. The management of medication becomes a complex element for the patient/family member or caregiver.Determine the factors associated with therapeutic complexity according to the dimensions of needs determined with HexCom. Longitudinal observational study of a multicentre cohort. Therapeutic complexity was chosen as dependent variable. Independent variables: socio-demographic, relationship with the caregiver, pathologies and groups of advanced diseases, functional and mental status, six HexCom domains and diagnosis that most contributes to the death process. All these variables were assessed initially and the HexCom variables were also assessed after the patients death. A multivariate Poisson regression analysis was performed. The scope of the study is palliative home care in Catalonia. The cohort included 1,677 patients. Recruitment was performed by consecutive sampling. The results show a strong relationship of the initial therapeutic complexity with the difficulty in managing symptoms (OR 4.56), dying process (OR 2.62), and difficulties in handling information about the diagnosis/prognosis (OR 2.04), bad family relationships (OR 1.82) and difficulties in handling the patients basic needs (OR 1.87). Regarding the final therapeutic complexity, two new factors have been identified, which are the difficulty in adapting the therapeutic effort (OR 1.58) and the lack of external support (OR 0.60). This last factor is the only one which decreases therapeutic complexity as the factor increases. In order to effectively manage medication, support is needed in social, family and ethical areas, in order to reduce therapeutic complexity.