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Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis

Fundación Cudeca, 29631 Málaga, Spain
Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
Escuela Andaluza de Salud Pública, 18011 Granada, Spain
Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
International Collaborative for Best Care for the Dying Person, Liverpool L3 9TA, UK
Pharmacology and Therapeutics Department, School of Medicine, University of Málaga, 29016 Málaga, Spain
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 1960;
Received: 17 May 2020 / Revised: 17 June 2020 / Accepted: 21 June 2020 / Published: 23 June 2020
(This article belongs to the Special Issue Clinical Medicine of Healthcare and Sustainability)
The current treatment approach for patients in palliative care (PC) requires a health model based on shared and individualised care, according to the degree of complexity encountered. The aims of this study were to describe the levels of complexity that may be present, to determine their most prevalent elements and to identify factors that may be related to palliative complexity in advanced-stage cancer patients. An observational retrospective study was performed of patients attended to at the Cudeca Hospice. Socio-demographic and clinical data were compiled, together with information on the patients’ functional and performance status (according to the Palliative Performance Scale (PPS)). The level of complexity was determined by the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal©) and classified as highly complex, complex or non-complex. The impact of the independent variables on PC complexity was assessed by multinomial logistic regression analysis. Of the 501 patients studied, 44.8% presented a situation classed as highly complex and another 44% were considered complex. The highly complex items most frequently observed were the absence or insufficiency of family support and/or caregivers (24.3%) and the presence of difficult-to-control symptoms (17.3%). The complex item most frequently observed was an abrupt change in the level of functional autonomy (47.6%). The main factor related to the presence of high vs. non-complexity was that of performance status (odds ratio (OR) = 10.68, 95% confidence interval (CI) = 2.81–40.52, for PPS values < 40%). However, age was inversely related to high complexity. This study confirms the high level of complexity present in patients referred to a PC centre. Determining the factors related to this complexity could help physicians identify situations calling for timely referral for specialised PC, such as a low PPS score. View Full-Text
Keywords: palliative care; complexity; advanced cancer; health care systems palliative care; complexity; advanced cancer; health care systems
MDPI and ACS Style

Carrasco-Zafra, M.I.; Gómez-García, R.; Ocaña-Riola, R.; Martín-Roselló, M.L.; Blanco-Reina, E. Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis. J. Clin. Med. 2020, 9, 1960.

AMA Style

Carrasco-Zafra MI, Gómez-García R, Ocaña-Riola R, Martín-Roselló ML, Blanco-Reina E. Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis. Journal of Clinical Medicine. 2020; 9(6):1960.

Chicago/Turabian Style

Carrasco-Zafra, Maria I., Rafael Gómez-García, Ricardo Ocaña-Riola, Maria L. Martín-Roselló, and Encarnación Blanco-Reina. 2020. "Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis" Journal of Clinical Medicine 9, no. 6: 1960.

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