Context Forecasts of profound demographic change and diminishing health care resources together with patient preferences to be cared for at home, suggest that future community support will need to be shaped very differently, identifying new sources of resilience.

Networks around people could be harnessed to offer social and practical support, and in many cases healthcare support. This underpins the public health approach to palliative care.

Proposal There is a presumption by practitioners that the traditional genogram describes the support network – this may be the case but it seems important to understand a more inclusive and interactive network, the strength and weakness of the links, potential for change and the conversations needed to facilitate strengthening of these links. Network ‘poor’ patients will also be identified.

The Social Universe Tool (based on Macy’s support map)

The palliative patient is given a blank sheet with their name in the centre and is asked to map all those people in their ‘universe’.

These may include :

Relatives, friends and neighbours

Facebook friends

Work colleagues

Members of groups or clubs

The thickness of arrows drawn in both directions between the patient and each name determines the strength of support given and received.

Reflections on conversations that need to happen to strengthen key relationships are formulated together

For example – there may be a thin line from a friend towards the patient – the patient feels this friend would like to help more – what conversation needs to happen to strengthen the universe ?

Initial results The Social Universe map has been piloted to look at acceptability and usability with 20 patients of different ages and backgrounds.

All patients have found it a creative and relevant way to understand their networks and to think about tactics to strengthen relationships !

Next Steps Formal evaluation with professionals and patients, followed by training of hospice practitioners to launch as part of routine holistic assessment.