Measuring the Complexity of Palliative Care: A Single-Center Retrospective Study.

Abstract

International guidelines recommend specialized palliative care for patients with complex care needs. However, scales assessing patient complexity should be modified according to each country and its healthcare systems. This study aimed to develop a scale for assessing the complexity of palliative care needs among patients referred to a palliative care unit and to determine its validity. We developed an 8-item COMPLEX scale (with each item scored 0-3 points) to assess patient complexity based on physicians' clinical reasoning and a literature review. Data were collected from a palliative care unit at a Japanese hospital between September 2022 and March 2023. The inclusion criteria were: (1) referral to a palliative care unit, and (2) any age, sex, or primary cancer focus. A total of 305 patients were included in the analysis. During the data collection period, 148 patients (48.5%) died. Regarding survival time analysis, patients were stratified into three groups based on their COMPLEX scale scores. At the time of referral to the palliative care unit, the mean survival time was 62.0 days for those with a score of ≤8, 51.1 days for those with scores of 9-10, and 48.8 days for those with a score of ≥11. Overall, patients with higher scores had significantly shorter survival times than those with lower scores (P = 0.037). The COMPLEX scale demonstrated meaningful associations with external indicators, such as survival time. Future studies should validate its reliability across diverse clinical settings, among various raters, and in relation to other external indicators.