A systematic review of classifications systems to determine complexity of patient care needs in palliative care

Abstract

Background: Providing the right care for each individual patient is a key element of quality palliative care. Complexity is a relatively new concept, defined as the nature of patients’ situations and the extent of resulting needs. Classifying patients according to the complexity of their care needs can guide integration of services, anticipatory discussions, health service planning, resource management and determination of needs for specialist or general palliative care. However, there is no consistent approach to interpreting and classifying complexity of patient needs. Aim: The aim of this article is to identify and describe classification systems for complexity of patient care needs in palliative care. Design: Narrative systematic review (PROSPERO registration number CRD42020182102). Data sources: MEDLINE, Embase, CINAHL and PsychINFO databases were searched without time limitations. Articles were included that described classification systems for complexity of care requirements in populations with palliative care needs. Results: In total, 4301 records were screened, with nine articles identified reporting the use of patient classification systems in populations with palliative care needs. These articles included the use of six classification systems: HexCom, Perroca Scale, AN-SNAP, Hui Major Criteria, IDC-Pal and PALCOM. These systems were heterogenous in the manner they determined complexity of care needs. The HexCom and IDC-Pal systems contained items that covered all domains of complexity as described by Hodiamont; personal, social support, health care team and environment. Conclusion: Although six classification systems have been developed, they access differing aspects of care needs and their application has been limited. The HexCOM and IDC-Pal systems offer the broadest determinations of complexity from an individual perspective. Further research is needed to apply these systems to populations external to those in which they were developed, and to appreciate how they may integrate with, and impact, clinical care.

Building a telepalliative care strategy in nursing homes: a qualitative study with mobile palliative care teams

“…Assessing the range of tele-palliative care services remains challenging because of the complexity of palliative care situations, which involve an intricate combination of clinical, social, cultural, ethical and psychological parameters [ 16 ]. In this regard, qualitative research methods hold promise as a means to assess telemedicine services [ 17 ].…”

Intra-rater reliability and feasibility of the HexCom advanced disease complexity assessment model

“…10 We have thus sought approval from the IDIAPJGol Clinical Research Ethics Committee for the formal study “Validation of an advanced disease complexity assessment model (HexCom)” (code 19/215-P), which is to be based on real patients rather than written cases and includes assessment of concurrent validation. 5 This study, however, is currently postponed due to the COVID-19 pandemic. If carrying out fieldwork becomes unfeasible, a set of videotaped role-play simulated situations would be used to test the HexCom tool.…”

“…In a recent systematic review, HexCom-Clin was deemed one of the most comprehensive complexity assessment tools for palliative care on the international stage. 5 The two instruments share domains and subdomains, which means the 18 subdomains of HexCom-Clin are covered by the six areas of both tools.…”

Gender and Observed Complexity in Palliative Home Care: A Prospective Multicentre Study Using the HexCom Model

“…The apparent validity shows a high level of agreement, with a content validity index (CVI-I) over 0.92 for the model and over 0.80 for all the derived instruments [ 17 , 21 ]. A recently published systematic review considers the HexCom model one of the most comprehensive for assessing complexity [ 18 ].…”

“…In this article, we explore the role of gender in the process of defining the complexity of each case. To do so, we draw on the Hexagon of Complexity (HexCom) [ 16 , 17 ], which defines complexity as the gap between the needs of the patient and available resources [ 4 ], registering it as a key element in the practice of palliative care [ 18 ].…”