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Instruments to evaluate complexity in end-of-life care

Martin-Rosello, Maria Luisaa,b; Sanz-Amores, Maria Reyesc; Salvador-Comino, Maria Rosad

Current Opinion in Supportive and Palliative Care: December 2018 - Volume 12 - Issue 4 - p 480–488
doi: 10.1097/SPC.0000000000000403
END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston

Purpose of review 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.

Recent findings 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.

Summary 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:

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