Social Determinants of Comfort: A New Term for End-of-Life Care

Social Determinants of Comfort

“…The concept of "social determinants of comfort" has been introduced and defined in a previous publication. 1 See Figure 2 for a map of the process.…”

“…In prior work, the concept of social determinants of comfort (SDOCs) described structural conditions that influence whether, to what degree, and in what forms comfort measures are offered to and accepted by patients and their families. 1 Social determinants of comfort include socioeconomic status, education, geographic area, physical environment, employment, social supports, and access to care. The definition is based on the etymology of the term comfort, which comes from Latin confortare, meaning to "strengthen greatly."…”

“…The term social determinants of comfort highlights these particular health disparities in the distinctively vulnerable setting of serious illness and end of life. 1 Thienprayoon and colleagues 4 examined how these domains of quality palliative care apply to pediatric palliative and end-of-life care, from health care providers' perspectives. They drew particular attention to the needs of siblings of children living with serious illness, the financial stress related to caring for a child with serious illness, maximizing school and community engagement opportunities for the child with serious illness, and access to adequate transportation and durable medical equipment to allow maximal participation in social life consistent with child and family goals.…”

The 2023-2026 Hospice and Palliative Nurses Association Research Agenda

“…We must also advance our understanding of the social determinants of pediatric serious illness. 92 Understanding the ordinary and extraordinary impact of juggling competing demands of caring for seriously ill children is critical to better supporting families. 93 As families care for their ill child and deal with the other responsibilities (eg, medical bills, copays, insurance) and costs associated with medical care (eg, hospital parking fees, meals, transportation to and from medical appointments), they also contend with the daily strains of their own healthcare needs and the healthcare needs of their other family members; employment; and schooling and child care for siblings.…”

“…Thus, researchers need to more closely explore and measure family life strains (such as time cost, financial stressors, material hardship, and employment challenges) and family life resources (such as social and psychological resources of individual family members and the family unit). 92,[95][96][97][98][99] This is especially important for families of medically complex children, 99 although we have a growing evidence base on how families of impact of serious illness on families of children who have lifelong medically complex serious illnesses. By assessing these challenges and resources from a holistic socioecological perspective, we can more readily partner with important stakeholders to address these multipronged challenges by building on family and community strengths.…”