Using the Complexity Adaptive System framework to guide hospice admissions, developing a supportive assessment tool

Background: Hospice admissions, from referral to evaluation, require an in-depth understanding of patient care needs, which is often insufficient in practice. The Complex Adaptive Systems (CAS) provides a framework that contains patient, social, team domains, along with environmental factors.
Aim/Research question or hypothesis: To develop an instrument using CAS to unravel patient care needs that can be used to guide hospice admissions from referral to evaluation.
Methods: A two-phase qualitative multi-method approach was employed:
Six focus groups (n=50) were conducted to identify elements essential for understanding patient care needs that are missing from standard hospice assessments, with two groups for each stage (referral, admission, and evaluation). A semi-structured interview guide based on the CAS domains was used, and thematic analysis was employed to identify key themes and potential instrument items. A Delphi technique (n=13) was used to engage participants to select key items within each CAS domain and stage. Content analyses identified the final selections.
Results: In phase 1, participants identified elements across all domains, leading to 41 items within six themes: information provision, appropriate setting, knowledge framework, family caregivers and loved ones, safety, and patient status.
In phase 2, five key items emerged as priorities across all CAS domains and stages: 1) patient and family expectations, 2) alignment of goals between family and hospice, 3) alignment of goals between family and patient, 4) collaboration with external organisations, and 5) the hospice team’s capacity and workload.
Discussion: Using CAS resulted in additional items for an instrument to guide hospice admissions and support clinicians in evaluating in-depth patient care needs. An initial instrument has been created and, combined with information gathered from standard hospice assessments, can be used to ensure appropriate care at the right time and place. This instrument will be further developed and refined in collaboration with hospices in the Netherlands.