The growing number of patients with terminal and chronic conditions and co-morbidities constitutes a challenge for any healthcare system, to provide effective and efficient patient-centred care at the end of life. Resources are limited, and complexity is rising within patients’ situations and healthcare professionals interventions. This review presents the state of art of the role of complexity in specialist palliative care provision.
Although studies related to complexity in palliative care are still limited, interesting reviews on complexity frameworks in co-morbidity conditions and palliative care are growing more present in current literature. They identify multidimensional issues, resource utilisation, and the relationship between them as fundamental aspects of complexity constructs, helping to define and understand complexity, and to therefore design validated tools to support healthcare professionals identifying the most complex patients, such as Hui's criteria, PALCOM, INTERMED, and IDC-Pal which is presented in this review.
There is an urgent need to guarantee quality and equity of care for all the patients eligible for palliative care, from those who need a palliative care approach to those needing specialist intensive palliative care. Implementing complexity theory into practice is paramount. In this review, complexity science, complexity frameworks, as well as tools evaluating complexity in palliative care are described.
aCudeca Hospice Foundation
bMalaga Biomedical Research Institute (IBIMA), Malaga-Gaudalhorce Health District, University of Malaga, Malaga
cGeneral Directorate for Research and Knowledge of the Andalusian Public Health Government, Seville, Spain
dPalliative Care Department, University of Munich, Munich, Germany
Correspondence to Maria Luisa Martin-Rosello, MD, Centro Cudeca, Avenida del Cosmos s/n. 29631 Benalmádena, Malaga, Spain. Tel: +34 647 810 270; e-mail: firstname.lastname@example.org