Family conferences in the approach to dependent patients with high clinical complexity: from family health teams to palliative care

Family conferences in the approach to dependent patients with high clinical complexity: from family health teams to palliative care | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Family conferences in the approach to dependent patients with high clinical complexity: from family health teams to palliative care Ana Nascimento, Joana Brandão-Silva, Daniela Cunha, Iliana Ramos, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7266017/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2026 Read the published version in BMC Palliative Care → Version 1 posted 10 You are reading this latest preprint version Abstract Introduction: Family conferences (FC) are a structured and therapeutic tool in palliative care, promoting effective communication between the healthcare team, patient and family. They are especially relevant for patients with high clinical complexity, both in hospital settings and in primary care. Objective: To evaluate the impact of FC on patients followed by palliative care teams and on complex patients dependent on primary health care (PHC), as well as the perception of caregivers on the quality of care provided. Methods: Observational, analytical and cross-sectional study, with application of a specific questionnaire to caregivers of patients followed by a community palliative care team and a family health team. Sociodemographic and clinical variables and perceptions of the impact of FC on the understanding of the disease and its trajectory, on satisfaction and on the feeling of security and trust were analyzed. Results: The total sample included 38 caregivers, of whom 20 were accompanied by a team specialized in palliative care and 18 by a family health team. There was a high percentage of female caregivers (78.9%), with a mean age of 58.1 years, and the mean age of patients was 80.7 years. FC was associated with improved perception of communication (9.36 ± 0.65), collaboration (9.50 ± 0.86) and implementation of care strategies (9.45 ± 0.83). The presence of professionals such as social workers and psychologists in the FC of the palliative care team associated with greater family participation (p = 0.002) and greater perceived support (p = 0.001). Among the patients who died, there was a significant correspondence between the desired and actual place of death (p = 0.007), demonstrating FC as an effective instrument for planning. The presence of more family members in the FC correlated with greater hospital use in the previous month (p < 0.001) and with greater case complexity. Discussion: FCs have proven to be effective in improving communication, planning and aligning care with patient and family preferences. Their regular implementation, especially in PHC, should be promoted with multidisciplinary teams and specific training. disease management home care primary care family care advance directives end-of-life care family therapy caregiver Introduction and objectives The importance of emotional and social support as essential components of care for people with palliative needs is currently emphasized, including support for family members and/or caregivers, recognizing that the absence of these can increase the complexity of the case. ( 1 , 2 , 4 ) Family conferences (FC) represent an essential therapeutic tool in palliative care, where the family is understood as an integral part of the care unit, assuming a fundamental role in emotional and functional adaptation to the challenge of caring for a person with a serious and life-threatening illness. ( 7 – 10 ) Caring for a patient at home places high demands on family members, generating emotional and physical overload. ( 9 ) However, when they receive adequate support, these families tend to present better emotional adjustment than those whose relatives remain hospitalized. ( 7 , 11 ) Caregivers often face difficulties due to a lack of adequate information and the absence of structured emotional support. This gap contributes to high levels of stress and anxiety. ( 12 – 14 ) In this context, it is essential that health professionals, especially family physicians, recognize and meet the needs of caregivers, from providing clear and realistic information to emotional support, respecting beliefs and actively participating in care and the grieving process. ( 12 , 13 , 15 ) The FC emerges as a structured response to these needs, functioning as a safe space for dialogue between the patient, family and healthcare team. ( 8 , 15 , 16 ) Planned in advance, its objectives are to clarify the trajectories of diseases, reviewing the patient's previous, current and future functionality, and to personalize the therapeutic approach to the patient-family unit, outlining an action plan. ( 7 , 15 , 16 ) At the same time, it allows for the validation of emotions, recognition of the efforts of caregivers and strengthening communication between all involved. ( 12 , 15 , 17 ) Despite the demands, the FC brings sustainable benefits, such as improving the quality of care, reducing unnecessary hospitalizations and promoting a more dignified end-of-life process. ( 8 , 16 ) Frequent conversations between health professionals, patients, and families rarely follow a formal model such as that recommended for FCs.( 16 , 18 ) As facilitators, FCs include a good doctor-patient-family relationship, diagnostic clarity, clinical experience, and the support of multidisciplinary teams trained in palliative care.( 13 , 15 ) Benefits include reduced suffering, strengthened family ties, more effective care plans, reduced need for emergency care, and increased psychological support.( 8 , 15 , 16 , 19 ) Conferences also help to demystify the topic of death, promoting a more empathetic approach.( 20 ) Despite the recognized benefits, several barriers to their systematic implementation have been identified, such as the lack of specific training to communicate bad news, time constraints, lack of financial return, lack of administrative support and scarcity of robust evidence proving the positive impacts of large-scale meetings. ( 5 , 13 , 15 , 21 ) Although more frequent in the hospital setting, the use of family conferences in primary health care (PHC) has gained recognition, especially in chronic disease situations, in patients with greater clinical complexity and in more challenging psychosocial contexts. ( 5 , 17 , 22 ) General and family practitioners should consider family conferences as an integral part of the care plan, seeking to involve the family as an active partner. ( 17 ) Therefore, the main objective of this study is to evaluate the impact of family conferences on patients followed by a palliative care team and complex dependent patients followed by PHC and their families. As secondary objectives, we intend to evaluate how family conferences are important for the knowledge and attitudes/skills of caregivers and even patients. To evaluate the perception of family members about the quality of care provided to the patient. Material and methods This is an observational, analytical and cross-sectional study, carried out with patients being followed by community palliative care teams, as well as dependent patients followed in PHC and their family members or caregivers. The main objective was to assess the family's perception regarding the care provided after FCs, through a questionnaire developed specifically for this study. Participation in the study was voluntary, preceded by informed consent, obtained in person by signing a specific form. In cases of significant cognitive impairment by the patient, the invitation to participate was addressed to their legal guardian. It was guaranteed that, under no circumstances, refusal to participate or failure to comply with the inclusion criteria would result in harm to the patients' usual health care. Ethical considerations: this study was conducted in accordance with the ethical principles set out in the World Medical Association's Declaration of Helsinki (2013 revision), as well as with European legislation on the protection of personal data, in particular Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 (General Data Protection Regulation – GDPR). The research received an authorization from the Ethics Committee of the Faculty of Medicine of the University of Coimbra (FMUC), under number CE-172/2024, issued following the meeting held on 20 November 2024. The study population included caregivers of patients monitored by a Community Palliative Care Team (CPCT) and caregivers of patients dependent on a Family Health Unit (FHU). The inclusion criteria used were: patients being monitored by the CPCT for more than a week, or, in the case of the FHU, being a dependent patient with a caregiver or family member responsible for continuous care, 24 hours a day. Recruitment was carried out among users of the units involved, with an invitation to participate and an explanation of the objectives of the study. The study was carried out between December 2024 and June 2025. Data collection was based on the application of a structured questionnaire (Appendix 1), applied to the patients' family members or caregivers after family conferences. The variables assessed included sociodemographic and clinical variables, as well as the perception of the family/caregivers regarding the care provided after the family conferences. The statistical analysis involved descriptive statistics (absolute and relative frequencies, means and respective standard deviations) and inferential statistics. In this, the Chi-square test of independence, Fisher's test, Mann-Whitney test, Kruskal-Wallis test, Pearson's correlation coefficient and Spearman's correlation coefficient were used. The normality of distribution was analyzed using the skewness and kurtosis. The Chi-square assumption that there should be no more than 20% of cells with expected frequencies below 5 was analyzed. In situations where this assumption was not met, the Chi-square test by Monte Carlo simulation was used. The differences were analyzed with the support of standardized adjusted residuals. The significance level for rejecting the null hypothesis was set at α ≤ .05. Statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) version 29.0 for Windows. Results The sample consisted of 38 participants, 20 caregivers of patients followed by a CPCT in the northern region of Portugal and 18 caregivers of patients dependent on a Family Health Unit (FHU) in the central region of Portugal. As can be seen in the sociodemographic characterization (Table 1 ), the average age of the caregivers was 58.1 (± 12.8) years, with the majority being female (78.9%). The average age of the patients was 80.7 (± 11.5) years, with a predominance of males (63.2%). Table 1 – Sociodemographic and Clinical Characterization of the Sample CPCT FHU Sample N % N % N % p Caregiver age (A) 55.7 12.9 60.7 12.5 58.1 12.8 Patient age (A) 76.6 13.6 85.4 6.3 80.7 11.5 Caregiver sex 1.000 Female 16 80.0% 14 77.8% 30 78.9% Male 4 20.0% 4 22.2% 8 21.1% Caregiver education 0.006 4th 2 10.0% 5 27.8% 7 18.4% 6th 0 0.0% 4 22.2% 4 10.5% 9th 4 20.0% 3 16.7% 7 18.4% 12nd 5 25.0% 6 33.3% 11 28.9% College degree 7 35.0% 0 0.0% 7 18.4% Master degree 2 10.0% 0 0.0% 2 5.3% Caregiver kinship 0.238 Spouse 4 20.0% 4 22.2% 8 21.1% Daughter 9 45.0% 9 50.0% 18 47.4% Son 0 0.0% 3 16.7% 3 7.9% Husband 5 25.0% 1 5.6% 6 15.8% Daughter-in-law 2 10.0% 1 5.6% 3 7.9% Patient’s sex 0.503 Female 6 30.0% 8 44.4% 14 36.8% Male 14 70.0% 10 55.6% 24 63.2% Patient main diagnosis 0.006 Stroke 0 0.0% 2 11.1% 2 5.3% Dementia 5 25.0% 6 33.3% 11 28.9% COPD 0 0.0% 2 11.1% 2 5.3% Hearth failure 3 15.0% 4 22.2% 7 18.4% Oncological disease 12 60.0% 2 11.1% 14 36.8% Osteoarticular 0 0.0% 2 11.1% 2 5.3% Patient clinical complexity 0.485 Mild-Moderate 7 35.0% 4 22.2% 11 28.9% High 13 65.0% 14 77.8% 27 71.1% CPCT = Community Palliative Care Team; FHU = Family Health Unit; p = significance; A = average; N = number; % = percentage; COPD = Chronic Obstructive Pulmonary Disease Statistically significant differences were observed between the groups (Table 1 ) in terms of caregiver educational level (p = 0.006), with the 6th year of education being more frequent in the FHU group (22.2%) and a bachelor's degree in the CPCT group (35.0%). Concerning clinical diagnosis of patients, a significant difference was also observed (p = 0.006), with a higher prevalence of oncological diagnoses in the CPCT (60.0%) and dementia in the FHU (33.3%). The presence of different professionals varied significantly between the groups, with a systematic presence of a social worker and a psychologist in the CPCT family conference (p < 0.001). In the total sample, 44.7% of the patients died, all followed by the CPCT. Table 2 shows the patients who died and those who are still alive, assessing their functionality and prognosis (by PPS) at the time of the FC, number of visits to the hospital in the last month (question no. 6.1 of the questionnaire) and number of family members and caregivers present at the FC. Table 2 – Patients who died and patients who remain alive and their functionality on the day of the Family Conference, caregivers and family members available and number of visits to the hospital Variable Still alive (n = 21) Death (n = 17) P PPS 36.19 ± 15.96 24.71 ± 8.74 0.031 Number of visits to the hospital in the last month 0.71 ± 0.90 3.71 ± 1.16 0.001 Number of family caregivers 0.33 ± 0.91 1.76 ± 0.97 0.001 Number of family members in FC 1.29 ± 0.90 2.41 ± 1.06 0.001 n = number; p = significance; PPS = Palliative Performance Scale; FC = family conference The PPS of patients who died was significantly lower than that of those who remained alive (p = 0.031). Of those who remained alive, the mean PPS value was 31.05 (± 14.29), with no statistically significant differences between patients followed by the CPCT and those followed by the USF (p = 0.239). The number of hospital visits in the month before the CF was significantly higher in patients who died (p = 0.001). Patients who died (n = 17) had a greater number of family caregivers (1.76 ± 0.97; p = 0.001) and a greater number of family members present at the FC (2.41±; 1.06; p = .001). Table 3 shows the questions included in the questionnaire that had statistical significance. Table 3 – Significant Correlations between Perception Variables (Total Sample) Correlated variables Coeficient (r) p Q8 × Q1 (participation × utility) 0.939 < 0.01 Q8 × Q3 (participation × collaboration) 0.968 < 0.01 Q8 × Q4 (participation × resolution) 0.914 < 0.01 Q8 × Q5 (participation × strategies) 0.974 < 0.01 Q7 × Q5 (clarity × strategies) 0.957 < 0.01 Q6.1 × number of family members present 0.727 < 0.001 Patient age × family members –0.326 0.046 Q = question of the questionnaire (Annex 1); p = significance In the analysis strong and significant associations were observed (p < 0.01) between the presence of the caregiver in the FC (Q8) and the perception of effectiveness in problem-solving (Q4), the successful implementation of discussed strategies (Q5) and the increase in collaboration in care (Q3), as well as between the perception of implementation of strategies (Q5) and the improvement in the clarity and understanding of information (Q7). A significant association was observed between the place of death and the desired place (χ² ( 2 ) = 11.694; p = 0.007), with death at home being more frequent among patients who expressed this preference. The existence of an informal caregiver was associated with the participants' level of education (p = 0.041), being more prevalent among caregivers with a 6th grade education. The total number of family members present at the CF correlated positively with the number of visits to the hospital in the month prior to the CF (rsp = 0.727; p < 0.001) and negatively with the patient's age (rsp = − 0.326; p = 0.046). The number of family members present was also significantly higher when the social worker was present (p = 0.002) and in cases where the patient ended up dying (p = 0.001). Regarding diagnosis, patients with oncological pathology had a higher frequency of death (78.6% vs. 27.3% with dementia; p = 0.041), lower mean age (70.71 ± 11.71 vs. 88.91 ± 6.76 with dementia; p = 0.001), greater number of family caregivers (1.64 ± 1.08 vs. 0.29 ± 0.49 with heart failure; p = 0.005), and greater number of family members present at the FC (2.29 ± 1.14 vs. 1.00 ± 0.00 with osteoarticular diagnoses; p = 0.015). Finally, the presence of a social worker was associated with a significantly higher number of hospital visits in the month before (p = 0.001) and in the month after the family conference (p = 0.035). Likewise, the presence of a psychologist was associated with a higher number of hospital visits in the month before the conference (p = 0.001). Discussion This study demonstrated that FC are an effective tool in approaching complex patients in the home context, reflecting positive impacts on caregivers' perception, care planning and congruence between preferences and clinical outcomes. The significant differences found between the CPCT and FHU groups, namely in the clinical and sociodemographic profile of patients, reveal two distinct realities of action. The CPCT mainly follows patients with an oncological diagnosis and limited prognosis, reflected by the higher death rate (85%) and lower PPS, which is in line with the literature that associates palliative care teams with advanced stages of the disease ( 6 , 7 ). The FHU, on the other hand, predominantly followed frail elderly people with chronic diseases, with a more longitudinal and less specialized profile, with no record of deaths during the study period. The high number of family caregivers and relatives present in the FC in cases of patients who ended up dying, especially in cancer patients, reflects the mobilization of support networks in times of greatest emotional demand, as also observed by Moraes et al (2025), who highlight the increased burden on caregivers in terminal phases ( 10 ). The presence of a social worker and a psychologist present in the ECSCP showed an association with greater family participation and perception of support. This association is consistent with studies that demonstrate that multidisciplinary teams improve care coordination, communication and the caregiver experience ( 7 , 11 , 12 ). In the case where the endpoint was death, the significant correlation between the place of death and the place previously desired by the patient (p = 0.007) reinforces the effectiveness of FC as an instrument for advance care planning. This congruence is widely recognized as an indicator of quality in palliative care, promoting dignity and respect for patient autonomy ( 13 , 15 ). Another relevant finding was the negative correlation between the patient's age and the number of family members present, suggesting that, at older ages, support networks become less available or more fragile. This reinforces the need for strategies involving the community and social services to overcome loneliness and lack of support. ( 5 , 10 ). The association of variables such as collaboration, problem-solving and implementation of strategies with the presence of caregivers in the FC confirms the perception of effectiveness and improvement of care. These results are in line with the studies by Hudson et al. (2008), Cahill et al. (2021) and Bajt et al. (2025), which demonstrate that well-structured FC reduce anxiety, improve health literacy and favor more shared decisions ( 12 , 15 , 21 , 23 ). However, as identified by Dev et al. (2013), the presence of the patient in the FC may limit the emotional expression of caregivers and family members, for fear of aggravating the patient's suffering. Even so, their participation continues to be seen as beneficial for the alignment of care goals ( 9 ). When adequately structured and supported by multidisciplinary teams, FCs not only increased caregiver satisfaction but also contribute to reducing unplanned hospitalizations, as indicated by the significant decrease in hospital visits before and after FC in patients who died, reflecting greater care intensity in the month prior to death. These results are in agreement with Dev et al. (2013) and Werdhani et al. (2021). ( 7 , 11 , 17 ) Finally, the importance of specific training for professionals in conducting these meetings is highlighted, especially in the context of primary care, where the application of FCs is still less systematic. Studies such as those by Kalitzkus et al. (2022) and Bajt et al. (2025) recommend the implementation of formal and standardized models to maximize the impact of FCs in PHC. ( 17 , 19 , 21 ) Conclusions Regarding the main objective, which was to evaluate the impact of family conferences on patients followed by a palliative care team and on complex dependent patients followed in PHC, as well as on their families, the results demonstrated that FC are an effective tool and well received by caregivers and family members. Participation in FC was linked to better teamwork, clearer communication, and more effective care strategies, with a strong alignment between patients' preferred and actual place of death, highlighting its positive impact on end-of-life care planning. FC implementation improved caregivers’ and patients’ understanding of needs and enhanced family members’ perception of care quality, fostering stronger alignment with the health team and greater confidence in the therapeutic plan, especially when supported by psychosocial professionals. Strengthening health literacy, training teams to conduct these meetings and their systematic inclusion in the follow-up of complex patients should be considered as priorities in the organization of palliative care and primary health care. Declarations -Ethics approval and consent to participate: this study was conducted in accordance with the ethical principles set out in the World Medical Association's Declaration of Helsinki (2013 revision), as well as with European legislation on the protection of personal data, in particular Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 (General Data Protection Regulation – GDPR). The research received an authorization from the Ethics Committee of the Faculty of Medicine of the University of Coimbra (FMUC), under number CE-172/2024, issued following the meeting held on 20 November 2024. All participants signed a informed consent previously to questionnaire. -Consent for publication: Not applicable for participants. All authors have read and agreed to the published version of the manuscript. -Availability of data and materials: under reasonable request. -Competing interests: Nothing to declare. -Funding: This research was supported by National Funds through FCT—Fundação para a Ciência e Tecnologia, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020) and within the scope of the project RISE, Associated Laboratory (reference LA/P/0053/2020). -Authors' contributions: Conceptualization, A.N. and H.R.; methodology, A.N., J.B.S. and H.R.; software, D.C., J.R.N.; validation, C.P., V.S. and J.R.N.; formal analysis, J.P.A. and H.R.; investigation, A.N. and H.R.; resources, A.N. and H.R.; data curation, J.B.S. and J.R.N.; writing—original draft preparation, A.N. and H.R.; writing—review and editing, J.B.S., D.C., I.R., C.P., V.S., J.R.N., M.D. and H.R.; visualization, C.P., V.S., J.P.A. and M.D.; supervision, H.R.; project administration, H.R.; funding acquisition, H.R., J.P.A. and J.R.N. 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Supplementary Files Annex1familyconferences.docx Cite Share Download PDF Status: Published Journal Publication published 09 Jan, 2026 Read the published version in BMC Palliative Care → Version 1 posted Editorial decision: Revision requested 30 Oct, 2025 Reviews received at journal 13 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers agreed at journal 26 Sep, 2025 Reviewers invited by journal 25 Sep, 2025 Editor assigned by journal 17 Aug, 2025 Editor invited by journal 14 Aug, 2025 Submission checks completed at journal 14 Aug, 2025 First submitted to journal 14 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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17:56:30","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101454,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7266017/v1/82774efe2f15c6ab148f2dcb.html"},{"id":100069980,"identity":"43ae88d6-4b05-40c7-88e3-138205997ee1","added_by":"auto","created_at":"2026-01-12 16:15:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":760467,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7266017/v1/a32c968f-702d-423d-9882-fb772e38b80b.pdf"},{"id":93071372,"identity":"1d08251b-a1e0-4448-9f16-5f0dedc311f4","added_by":"auto","created_at":"2025-10-08 17:56:30","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29388,"visible":true,"origin":"","legend":"","description":"","filename":"Annex1familyconferences.docx","url":"https://assets-eu.researchsquare.com/files/rs-7266017/v1/b962f5ccbd48cfea9cb90a7a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Family conferences in the approach to dependent patients with high clinical complexity: from family health teams to palliative care","fulltext":[{"header":"Introduction and objectives","content":"\u003cp\u003eThe importance of emotional and social support as essential components of care for people with palliative needs is currently emphasized, including support for family members and/or caregivers, recognizing that the absence of these can increase the complexity of the case. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eFamily conferences (FC) represent an essential therapeutic tool in palliative care, where the family is understood as an integral part of the care unit, assuming a fundamental role in emotional and functional adaptation to the challenge of caring for a person with a serious and life-threatening illness. (\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eCaring for a patient at home places high demands on family members, generating emotional and physical overload. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) However, when they receive adequate support, these families tend to present better emotional adjustment than those whose relatives remain hospitalized. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eCaregivers often face difficulties due to a lack of adequate information and the absence of structured emotional support. This gap contributes to high levels of stress and anxiety. (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIn this context, it is essential that health professionals, especially family physicians, recognize and meet the needs of caregivers, from providing clear and realistic information to emotional support, respecting beliefs and actively participating in care and the grieving process. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe FC emerges as a structured response to these needs, functioning as a safe space for dialogue between the patient, family and healthcare team. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003cp\u003ePlanned in advance, its objectives are to clarify the trajectories of diseases, reviewing the patient's previous, current and future functionality, and to personalize the therapeutic approach to the patient-family unit, outlining an action plan. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAt the same time, it allows for the validation of emotions, recognition of the efforts of caregivers and strengthening communication between all involved. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDespite the demands, the FC brings sustainable benefits, such as improving the quality of care, reducing unnecessary hospitalizations and promoting a more dignified end-of-life process. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eFrequent conversations between health professionals, patients, and families rarely follow a formal model such as that recommended for FCs.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) As facilitators, FCs include a good doctor-patient-family relationship, diagnostic clarity, clinical experience, and the support of multidisciplinary teams trained in palliative care.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Benefits include reduced suffering, strengthened family ties, more effective care plans, reduced need for emergency care, and increased psychological support.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Conferences also help to demystify the topic of death, promoting a more empathetic approach.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDespite the recognized benefits, several barriers to their systematic implementation have been identified, such as the lack of specific training to communicate bad news, time constraints, lack of financial return, lack of administrative support and scarcity of robust evidence proving the positive impacts of large-scale meetings. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAlthough more frequent in the hospital setting, the use of family conferences in primary health care (PHC) has gained recognition, especially in chronic disease situations, in patients with greater clinical complexity and in more challenging psychosocial contexts. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) General and family practitioners should consider family conferences as an integral part of the care plan, seeking to involve the family as an active partner. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eTherefore, the main objective of this study is to evaluate the impact of family conferences on patients followed by a palliative care team and complex dependent patients followed by PHC and their families. As secondary objectives, we intend to evaluate how family conferences are important for the knowledge and attitudes/skills of caregivers and even patients. To evaluate the perception of family members about the quality of care provided to the patient.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThis is an observational, analytical and cross-sectional study, carried out with patients being followed by community palliative care teams, as well as dependent patients followed in PHC and their family members or caregivers. The main objective was to assess the family's perception regarding the care provided after FCs, through a questionnaire developed specifically for this study.\u003c/p\u003e\u003cp\u003e Participation in the study was voluntary, preceded by informed consent, obtained in person by signing a specific form. In cases of significant cognitive impairment by the patient, the invitation to participate was addressed to their legal guardian. It was guaranteed that, under no circumstances, refusal to participate or failure to comply with the inclusion criteria would result in harm to the patients' usual health care.\u003c/p\u003e\u003cp\u003e Ethical considerations: this study was conducted in accordance with the ethical principles set out in the World Medical Association's Declaration of Helsinki (2013 revision), as well as with European legislation on the protection of personal data, in particular Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 (General Data Protection Regulation \u0026ndash; GDPR). The research received an authorization from the Ethics Committee of the Faculty of Medicine of the University of Coimbra (FMUC), under number CE-172/2024, issued following the meeting held on 20 November 2024.\u003c/p\u003e\u003cp\u003eThe study population included caregivers of patients monitored by a Community Palliative Care Team (CPCT) and caregivers of patients dependent on a Family Health Unit (FHU). The inclusion criteria used were: patients being monitored by the CPCT for more than a week, or, in the case of the FHU, being a dependent patient with a caregiver or family member responsible for continuous care, 24 hours a day.\u003c/p\u003e\u003cp\u003eRecruitment was carried out among users of the units involved, with an invitation to participate and an explanation of the objectives of the study. The study was carried out between December 2024 and June 2025. Data collection was based on the application of a structured questionnaire (Appendix 1), applied to the patients' family members or caregivers after family conferences.\u003c/p\u003e\u003cp\u003eThe variables assessed included sociodemographic and clinical variables, as well as the perception of the family/caregivers regarding the care provided after the family conferences.\u003c/p\u003e\u003cp\u003eThe statistical analysis involved descriptive statistics (absolute and relative frequencies, means and respective standard deviations) and inferential statistics. In this, the Chi-square test of independence, Fisher's test, Mann-Whitney test, Kruskal-Wallis test, Pearson's correlation coefficient and Spearman's correlation coefficient were used. The normality of distribution was analyzed using the skewness and kurtosis. The Chi-square assumption that there should be no more than 20% of cells with expected frequencies below 5 was analyzed. In situations where this assumption was not met, the Chi-square test by Monte Carlo simulation was used. The differences were analyzed with the support of standardized adjusted residuals.\u003c/p\u003e\u003cp\u003eThe significance level for rejecting the null hypothesis was set at α\u0026thinsp;\u0026le;\u0026thinsp;.05. Statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) version 29.0 for Windows.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe sample consisted of 38 participants, 20 caregivers of patients followed by a CPCT in the northern region of Portugal and 18 caregivers of patients dependent on a Family Health Unit (FHU) in the central region of Portugal.\u003c/p\u003e\u003cp\u003eAs can be seen in the sociodemographic characterization (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), the average age of the caregivers was 58.1 (\u0026plusmn;\u0026thinsp;12.8) years, with the majority being female (78.9%). The average age of the patients was 80.7 (\u0026plusmn;\u0026thinsp;11.5) years, with a predominance of males (63.2%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Sociodemographic and Clinical Characterization of the Sample\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCPCT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eFHU\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eSample\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaregiver age (A)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e58.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatient age (A)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaregiver sex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e78.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaregiver education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4th\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6th\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9th\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12nd\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollege degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaster degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaregiver kinship\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.238\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDaughter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHusband\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDaughter-in-law\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatient\u0026rsquo;s sex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.503\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e36.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e63.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatient main diagnosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCOPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHearth failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOncological disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e36.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOsteoarticular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePatient clinical complexity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.485\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild-Moderate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e71.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eCPCT\u0026thinsp;=\u0026thinsp;Community Palliative Care Team; FHU\u0026thinsp;=\u0026thinsp;Family Health Unit; p\u0026thinsp;=\u0026thinsp;significance; A\u0026thinsp;=\u0026thinsp;average; N\u0026thinsp;=\u0026thinsp;number; % = percentage; COPD\u0026thinsp;=\u0026thinsp;Chronic Obstructive Pulmonary Disease\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eStatistically significant differences were observed between the groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) in terms of caregiver educational level (p\u0026thinsp;=\u0026thinsp;0.006), with the 6th year of education being more frequent in the FHU group (22.2%) and a bachelor's degree in the CPCT group (35.0%).\u003c/p\u003e\u003cp\u003eConcerning clinical diagnosis of patients, a significant difference was also observed (p\u0026thinsp;=\u0026thinsp;0.006), with a higher prevalence of oncological diagnoses in the CPCT (60.0%) and dementia in the FHU (33.3%).\u003c/p\u003e\u003cp\u003eThe presence of different professionals varied significantly between the groups, with a systematic presence of a social worker and a psychologist in the CPCT family conference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eIn the total sample, 44.7% of the patients died, all followed by the CPCT.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the patients who died and those who are still alive, assessing their functionality and prognosis (by PPS) at the time of the FC, number of visits to the hospital in the last month (question no. 6.1 of the questionnaire) and number of family members and caregivers present at the FC.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Patients who died and patients who remain alive and their functionality on the day of the Family Conference, caregivers and family members available and number of visits to the hospital\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStill alive\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePPS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e36.19\u0026thinsp;\u0026plusmn;\u0026thinsp;15.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e24.71\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of visits to the hospital in the last month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of family caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of family members in FC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003en\u0026thinsp;=\u0026thinsp;number; p\u0026thinsp;=\u0026thinsp;significance; PPS\u0026thinsp;=\u0026thinsp;Palliative Performance Scale; FC\u0026thinsp;=\u0026thinsp;family conference\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe PPS of patients who died was significantly lower than that of those who remained alive (p\u0026thinsp;=\u0026thinsp;0.031). Of those who remained alive, the mean PPS value was 31.05 (\u0026plusmn;\u0026thinsp;14.29), with no statistically significant differences between patients followed by the CPCT and those followed by the USF (p\u0026thinsp;=\u0026thinsp;0.239).\u003c/p\u003e\u003cp\u003eThe number of hospital visits in the month before the CF was significantly higher in patients who died (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003ePatients who died (n\u0026thinsp;=\u0026thinsp;17) had a greater number of family caregivers (1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97; p\u0026thinsp;=\u0026thinsp;0.001) and a greater number of family members present at the FC (2.41\u0026plusmn;; 1.06; p\u0026thinsp;=\u0026thinsp;.001).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the questions included in the questionnaire that had statistical significance.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u0026ndash; Significant Correlations between Perception Variables (Total Sample)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCorrelated variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoeficient (r)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ8 \u0026times; Q1 (participation \u0026times; utility)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.939\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ8 \u0026times; Q3 (participation \u0026times; collaboration)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.968\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ8 \u0026times; Q4 (participation \u0026times; resolution)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.914\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ8 \u0026times; Q5 (participation \u0026times; strategies)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.974\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ7 \u0026times; Q5 (clarity \u0026times; strategies)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.957\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ6.1 \u0026times; number of family members present\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.727\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient age \u0026times; family members\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;0.326\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eQ\u0026thinsp;=\u0026thinsp;question of the questionnaire (Annex 1); p\u0026thinsp;=\u0026thinsp;significance\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the analysis strong and significant associations were observed (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) between the presence of the caregiver in the FC (Q8) and the perception of effectiveness in problem-solving (Q4), the successful implementation of discussed strategies (Q5) and the increase in collaboration in care (Q3), as well as between the perception of implementation of strategies (Q5) and the improvement in the clarity and understanding of information (Q7).\u003c/p\u003e\u003cp\u003eA significant association was observed between the place of death and the desired place (χ\u0026sup2; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;11.694; p\u0026thinsp;=\u0026thinsp;0.007), with death at home being more frequent among patients who expressed this preference.\u003c/p\u003e\u003cp\u003eThe existence of an informal caregiver was associated with the participants' level of education (p\u0026thinsp;=\u0026thinsp;0.041), being more prevalent among caregivers with a 6th grade education.\u003c/p\u003e\u003cp\u003eThe total number of family members present at the CF correlated positively with the number of visits to the hospital in the month prior to the CF (rsp\u0026thinsp;=\u0026thinsp;0.727; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and negatively with the patient's age (rsp = \u0026minus;\u0026thinsp;0.326; p\u0026thinsp;=\u0026thinsp;0.046). The number of family members present was also significantly higher when the social worker was present (p\u0026thinsp;=\u0026thinsp;0.002) and in cases where the patient ended up dying (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eRegarding diagnosis, patients with oncological pathology had a higher frequency of death (78.6% vs. 27.3% with dementia; p\u0026thinsp;=\u0026thinsp;0.041), lower mean age (70.71\u0026thinsp;\u0026plusmn;\u0026thinsp;11.71 vs. 88.91\u0026thinsp;\u0026plusmn;\u0026thinsp;6.76 with dementia; p\u0026thinsp;=\u0026thinsp;0.001), greater number of family caregivers (1.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08 vs. 0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49 with heart failure; p\u0026thinsp;=\u0026thinsp;0.005), and greater number of family members present at the FC (2.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14 vs. 1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00 with osteoarticular diagnoses; p\u0026thinsp;=\u0026thinsp;0.015).\u003c/p\u003e\u003cp\u003eFinally, the presence of a social worker was associated with a significantly higher number of hospital visits in the month before (p\u0026thinsp;=\u0026thinsp;0.001) and in the month after the family conference (p\u0026thinsp;=\u0026thinsp;0.035). Likewise, the presence of a psychologist was associated with a higher number of hospital visits in the month before the conference (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrated that FC are an effective tool in approaching complex patients in the home context, reflecting positive impacts on caregivers' perception, care planning and congruence between preferences and clinical outcomes.\u003c/p\u003e\u003cp\u003eThe significant differences found between the CPCT and FHU groups, namely in the clinical and sociodemographic profile of patients, reveal two distinct realities of action. The CPCT mainly follows patients with an oncological diagnosis and limited prognosis, reflected by the higher death rate (85%) and lower PPS, which is in line with the literature that associates palliative care teams with advanced stages of the disease (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The FHU, on the other hand, predominantly followed frail elderly people with chronic diseases, with a more longitudinal and less specialized profile, with no record of deaths during the study period.\u003c/p\u003e\u003cp\u003eThe high number of family caregivers and relatives present in the FC in cases of patients who ended up dying, especially in cancer patients, reflects the mobilization of support networks in times of greatest emotional demand, as also observed by Moraes et al (2025), who highlight the increased burden on caregivers in terminal phases (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The presence of a social worker and a psychologist present in the ECSCP showed an association with greater family participation and perception of support. This association is consistent with studies that demonstrate that multidisciplinary teams improve care coordination, communication and the caregiver experience (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the case where the endpoint was death, the significant correlation between the place of death and the place previously desired by the patient (p\u0026thinsp;=\u0026thinsp;0.007) reinforces the effectiveness of FC as an instrument for advance care planning. This congruence is widely recognized as an indicator of quality in palliative care, promoting dignity and respect for patient autonomy (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother relevant finding was the negative correlation between the patient's age and the number of family members present, suggesting that, at older ages, support networks become less available or more fragile. This reinforces the need for strategies involving the community and social services to overcome loneliness and lack of support. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe association of variables such as collaboration, problem-solving and implementation of strategies with the presence of caregivers in the FC confirms the perception of effectiveness and improvement of care. These results are in line with the studies by Hudson et al. (2008), Cahill et al. (2021) and Bajt et al. (2025), which demonstrate that well-structured FC reduce anxiety, improve health literacy and favor more shared decisions (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, as identified by Dev et al. (2013), the presence of the patient in the FC may limit the emotional expression of caregivers and family members, for fear of aggravating the patient's suffering. Even so, their participation continues to be seen as beneficial for the alignment of care goals (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhen adequately structured and supported by multidisciplinary teams, FCs not only increased caregiver satisfaction but also contribute to reducing unplanned hospitalizations, as indicated by the significant decrease in hospital visits before and after FC in patients who died, reflecting greater care intensity in the month prior to death. These results are in agreement with Dev et al. (2013) and Werdhani et al. (2021). (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) Finally, the importance of specific training for professionals in conducting these meetings is highlighted, especially in the context of primary care, where the application of FCs is still less systematic. Studies such as those by Kalitzkus et al. (2022) and Bajt et al. (2025) recommend the implementation of formal and standardized models to maximize the impact of FCs in PHC. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eRegarding the main objective, which was to evaluate the impact of family conferences on patients followed by a palliative care team and on complex dependent patients followed in PHC, as well as on their families, the results demonstrated that FC are an effective tool and well received by caregivers and family members. Participation in FC was linked to better teamwork, clearer communication, and more effective care strategies, with a strong alignment between patients' preferred and actual place of death, highlighting its positive impact on end-of-life care planning.\u003c/p\u003e\u003cp\u003eFC implementation improved caregivers\u0026rsquo; and patients\u0026rsquo; understanding of needs and enhanced family members\u0026rsquo; perception of care quality, fostering stronger alignment with the health team and greater confidence in the therapeutic plan, especially when supported by psychosocial professionals. Strengthening health literacy, training teams to conduct these meetings and their systematic inclusion in the follow-up of complex patients should be considered as priorities in the organization of palliative care and primary health care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e-Ethics approval and consent to participate:\u0026nbsp;\u003c/strong\u003ethis study was conducted in accordance with the ethical principles set out in the World Medical Association\u0026apos;s Declaration of Helsinki (2013 revision), as well as with European legislation on the protection of personal data, in particular Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 (General Data Protection Regulation \u0026ndash; GDPR). The research received an authorization from the Ethics Committee of the Faculty of Medicine of the University of Coimbra (FMUC), under number CE-172/2024, issued following the meeting held on 20 November 2024. All participants signed a informed consent previously to questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Consent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable for participants.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAll authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Availability of data and materials:\u0026nbsp;\u003c/strong\u003eunder reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Competing interests:\u0026nbsp;\u003c/strong\u003eNothing to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-Funding:\u0026nbsp;\u003c/strong\u003eThis research was supported by National Funds through FCT\u0026mdash;Funda\u0026ccedil;\u0026atilde;o para a Ci\u0026ecirc;ncia e Tecnologia, I.P., within CINTESIS, R\u0026amp;D Unit (reference UIDB/4255/2020) and within the scope of the project RISE, Associated Laboratory (reference LA/P/0053/2020).\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;-Authors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eConceptualization, A.N. and H.R.; methodology, A.N., J.B.S. and H.R.; software, D.C., J.R.N.; validation, C.P., V.S. and J.R.N.; formal analysis, J.P.A. and H.R.; investigation, A.N. and H.R.; resources, A.N. and H.R.; data curation, J.B.S. and J.R.N.; writing\u0026mdash;original draft preparation, A.N. and H.R.; writing\u0026mdash;review and editing, J.B.S., D.C., I.R.,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eC.P., V.S., J.R.N., M.D. and H.R.; visualization, C.P., V.S., J.P.A. and M.D.; supervision, H.R.; project administration, H.R.; funding acquisition, H.R., J.P.A. and J.R.N.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNicolaus S, Crelier B, Donz\u0026eacute; JD, Aubert CE. Definition of patient complexity in adults: A narrative review. J Multimorbidity Comorbidity. 2022;12:263355652210812. \u003c/li\u003e\n\u003cli\u003eOhinata H, Aoyama M, Miyashita M. Complexity in the context of palliative care: a systematic review. Ann Palliat Med. 2022;11(10):3231\u0026ndash;46. \u003c/li\u003e\n\u003cli\u003eBen-Menahem S, Sialm A, Hachfeld A, Rauch A, Von Krogh G, Furrer H. How do healthcare providers construe patient complexity? A qualitative study of multimorbidity in HIV outpatient clinical practice. BMJ Open. 2021;11(11):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eComiss\u0026atilde;o Nacional de Cuidados Paliativos. Plano estrat\u0026eacute;gico para o desenvolvimento dos cuidados paliativos 2023-2024. Acss. 2023;1\u0026ndash;35. \u003c/li\u003e\n\u003cli\u003eHeng MTM, Seng GYT, Lee ES. Challenges of care coordination for complex patients among family medicine residents in a community ambulatory clinic: a qualitative study. BMC Med Educ. 2024;24(1):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eRubio-Fern\u0026aacute;ndez E, Rosino-Bosch A, Alonso-Fern\u0026aacute;ndez S, Ruiz-Rosino M, Garc\u0026iacute;a-Sierra RM, Benito-Aracil L, et al. Multidimensional characteristics of complex chronic patients in emergency services in primary care. Collegian. 2023;30(1):94\u0026ndash;100. \u003c/li\u003e\n\u003cli\u003ePaliativos C. A confer\u0026ecirc;ncia familiar como instrumento de apoio \u0026agrave; fam\u0026iacute;lia em cuidados paliativos. Rev Port Cl\u0026iacute;nica Geral [Internet]. 2003;19(CUIDADOS PALIATIVOS):68\u0026ndash;74. https://rpmgf.pt/ojs/index.php/rpmgf/article/view/9906\u003c/li\u003e\n\u003cli\u003eGlajchen M, Goehring A, Johns H, Portenoy RK. Family Meetings in Palliative Care: Benefits and Barriers. Curr Treat Options Oncol. 2022;23(5):658\u0026ndash;67. \u003c/li\u003e\n\u003cli\u003ePerpi\u0026ntilde;\u0026aacute;-Galva\u0026ntilde; J, Orts-Beneito N, Fern\u0026aacute;ndez-Alc\u0026aacute;ntara M, Garc\u0026iacute;a-Sanju\u0026aacute;n S, Garc\u0026iacute;a-Caro M, Caba\u0026ntilde;ero-Mart\u0026iacute;nez M. Level of burden and health-related quality of life in caregivers of palliative care patients. International Journal of Environmental Research and Public Health [revista en Internet] 2019 [acceso 2 de setiembre de 2020]; 16(29): 2-13. Int J Environ Res Public Health. 2019;16(23):4806. \u003c/li\u003e\n\u003cli\u003eMoraes L, Telles A. Network of formal and informal care provided by family members for cancer patients receiving palliative care at home. Cien Saude Colet. 2025;v.30, n.5. \u003c/li\u003e\n\u003cli\u003eDev R, Coulson L, Del Fabbro E, Palla SL, Yennurajalingam S, Rhondali W, et al. A prospective study of family conferences: Effects of patient presence on emotional expression and end-of-life discussions. J Pain Symptom Manage [Internet]. 2013;46(4):536\u0026ndash;45. http://dx.doi.org/10.1016/j.jpainsymman.2012.10.280\u003c/li\u003e\n\u003cli\u003eLoupis YM, Faux SG. Family conferences in stroke rehabilitation: A literature review. J Stroke Cerebrovasc Dis [Internet]. 2013;22(6):883\u0026ndash;93. Available from: http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2012.12.003\u003c/li\u003e\n\u003cli\u003eDionne-Odom JN, Azuero A, Lyons KD, Hull JG, Tosteson T, Li Z, et al. Benefits of early versus delayed palliative care to informal family caregivers of patients with advanced cancer: Outcomes from the ENABLE III randomized controlled trial. J Clin Oncol. 2015;33(13):1446\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003eEtters L, Goodall D, Harrison BE. Caregiver burden among dementia patient caregivers: A review of the literature. J Am Acad Nurse Pract. 2008;20(8):423\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eCahill PJ, Lobb EA, Sanderson CR, Phillips JL. Patients Receiving Palliative Care and Their Families\u0026rsquo; Experiences of Participating in a \u0026ldquo;patient-Centered Family Meeting\u0026rdquo;: A Qualitative Substudy of the Valuing Opinions, Individual Communication, and Experience Feasibility Trial. Palliat Med Reports. 2021;2(1):305\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003ePowazki RD, Walsh D. The family conference in palliative medicine: A practical approach. Am J Hosp Palliat Med. 2014;31(6):678\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eWerdhani RA, Trisna DV. Family Conference In Primary Care Practice. J Indones Med Assoc. 2021;70(12):243\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eSanderson CR, Cahill PJ, Phillips JL, Johnson A, Lobb EA. Patient-centered family meetings in palliative care: A quality improvement project to explore a new model of family meetings with patients and families at the end of life. Ann Palliat Med. 2017;6(Suppl 2):S195\u0026ndash;205. \u003c/li\u003e\n\u003cli\u003eCahill PJ, Lobb EA, Sanderson C, Phillips JL. What is the evidence for conducting palliative care family meetings? A systematic review. Palliat Med. 2017;31(3):197\u0026ndash;211. \u003c/li\u003e\n\u003cli\u003eKeeley MP. Family communication at the end of life. Behav Sci (Basel). 2017;7(3):1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eBajt M, Klip\u0026scaron;teter LJ, Zelko E, Logatec Z. Barriers and facilitators of family meetings in primary palliative care : insights from slovenia. 2025;64(2):112\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eKalitzkus V, Steinhoff P, Wilm S, Mortsiefer A. Recommendations for the Use of Family Conferences in Family Medicine-a Scoping Review. Z Allgemeinmed. 2022;98(11):377\u0026ndash;85. \u003c/li\u003e\n\u003cli\u003eHudson P, Quinn K, O\u0026rsquo;Hanlon B, Aranda S. Family meetings in palliative care: Multidisciplinary clinical practice guidelines. BMC Palliat Care. 2008;7(1):1\u0026ndash;12. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"disease management, home care, primary care, family care, advance directives, end-of-life care, family therapy, caregiver","lastPublishedDoi":"10.21203/rs.3.rs-7266017/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7266017/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Family conferences (FC) are a structured and therapeutic tool in palliative care, promoting effective communication between the healthcare team, patient and family. They are especially relevant for patients with high clinical complexity, both in hospital settings and in primary care.\u003c/p\u003e\u003cp\u003eObjective: To evaluate the impact of FC on patients followed by palliative care teams and on complex patients dependent on primary health care (PHC), as well as the perception of caregivers on the quality of care provided.\u003c/p\u003e\u003cp\u003eMethods: Observational, analytical and cross-sectional study, with application of a specific questionnaire to caregivers of patients followed by a community palliative care team and a family health team. Sociodemographic and clinical variables and perceptions of the impact of FC on the understanding of the disease and its trajectory, on satisfaction and on the feeling of security and trust were analyzed.\u003c/p\u003e\u003cp\u003eResults: The total sample included 38 caregivers, of whom 20 were accompanied by a team specialized in palliative care and 18 by a family health team. There was a high percentage of female caregivers (78.9%), with a mean age of 58.1 years, and the mean age of patients was 80.7 years. FC was associated with improved perception of communication (9.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65), collaboration (9.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86) and implementation of care strategies (9.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83). The presence of professionals such as social workers and psychologists in the FC of the palliative care team associated with greater family participation (p\u0026thinsp;=\u0026thinsp;0.002) and greater perceived support (p\u0026thinsp;=\u0026thinsp;0.001). Among the patients who died, there was a significant correspondence between the desired and actual place of death (p\u0026thinsp;=\u0026thinsp;0.007), demonstrating FC as an effective instrument for planning. The presence of more family members in the FC correlated with greater hospital use in the previous month (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and with greater case complexity.\u003c/p\u003e\u003cp\u003eDiscussion: FCs have proven to be effective in improving communication, planning and aligning care with patient and family preferences. Their regular implementation, especially in PHC, should be promoted with multidisciplinary teams and specific training.\u003c/p\u003e","manuscriptTitle":"Family conferences in the approach to dependent patients with high clinical complexity: from family health teams to palliative care","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 17:56:26","doi":"10.21203/rs.3.rs-7266017/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-30T10:41:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-13T06:28:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T22:05:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314503649379569835734822124641631451268","date":"2025-09-29T05:53:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121364922196989834093166885935618403211","date":"2025-09-26T15:20:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T17:04:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-17T10:09:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-14T15:36:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-14T08:02:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2025-08-14T07:59:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7b5f9644-54f8-4d25-9a55-59fe6e66bdd7","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:08:21+00:00","versionOfRecord":{"articleIdentity":"rs-7266017","link":"https://doi.org/10.1186/s12904-025-01978-x","journal":{"identity":"bmc-palliative-care","isVorOnly":false,"title":"BMC Palliative Care"},"publishedOn":"2026-01-09 15:58:18","publishedOnDateReadable":"January 9th, 2026"},"versionCreatedAt":"2025-10-08 17:56:26","video":"","vorDoi":"10.1186/s12904-025-01978-x","vorDoiUrl":"https://doi.org/10.1186/s12904-025-01978-x","workflowStages":[]},"version":"v1","identity":"rs-7266017","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7266017","identity":"rs-7266017","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}