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

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 preval...

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Autores principales: Carrasco-Zafra, Maria Isabel, Gómez-García, Rafael, Ocaña-Riola, Ricardo, Martín-Roselló, Maria Luisa, Blanco-Reina, Encarnación
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356562/
https://www.ncbi.nlm.nih.gov/pubmed/32585859
http://dx.doi.org/10.3390/jcm9061960
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author Carrasco-Zafra, Maria Isabel
Gómez-García, Rafael
Ocaña-Riola, Ricardo
Martín-Roselló, Maria Luisa
Blanco-Reina, Encarnación
author_facet Carrasco-Zafra, Maria Isabel
Gómez-García, Rafael
Ocaña-Riola, Ricardo
Martín-Roselló, Maria Luisa
Blanco-Reina, Encarnación
author_sort Carrasco-Zafra, Maria Isabel
collection PubMed
description 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.
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spelling pubmed-73565622020-07-30 Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis Carrasco-Zafra, Maria Isabel Gómez-García, Rafael Ocaña-Riola, Ricardo Martín-Roselló, Maria Luisa Blanco-Reina, Encarnación J Clin Med Article 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. MDPI 2020-06-23 /pmc/articles/PMC7356562/ /pubmed/32585859 http://dx.doi.org/10.3390/jcm9061960 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Carrasco-Zafra, Maria Isabel
Gómez-García, Rafael
Ocaña-Riola, Ricardo
Martín-Roselló, Maria Luisa
Blanco-Reina, Encarnación
Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis
title Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis
title_full Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis
title_fullStr Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis
title_full_unstemmed Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis
title_short Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis
title_sort level of palliative care complexity in advanced cancer patients: a multinomial logistic analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356562/
https://www.ncbi.nlm.nih.gov/pubmed/32585859
http://dx.doi.org/10.3390/jcm9061960
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