Intra-rater reliability and feasibility of the HexCom advanced disease complexity assessment model

Busquet-Duran, Xavier; Esteban-Pérez, Manel; Manresa-Domínguez, Josep María; Moreno, Susana Martin; Lestón-Lado, Lola; Torán-Monserrat, Pere

doi:10.1016/j.aprim.2022.102343

Cited by 6 publications

(8 citation statements)

References 22 publications

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“…Several tools that define and categorise the construct of complexity of PC needs have been described (Hex-Com, Perroca-Scale, AN-SNAP, Hui-Major-Criteria, IDC-Pal, PALCOM). [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] All these tools include a multidimensional evaluation of the patient with the aim of establishing early referral criteria for multidisciplinary teams specialized in EPC. In some cases, the methodology of development of these scales is based on the consensus of experts regarding the conditions of complexity and their validation in transversal or Delphi studies [32][33][34], and in other cases it is based on prospective observational studies to determine predictive variables of complexity and their external validations (PALCOM scale) [31,46].…”

Section: Discussionmentioning

confidence: 99%

“…Barthel index ≤60 or Karnofsky index ≤50-60%) Complex systems are characterised by depending on the continuous interaction of multiple variables within an unstable equilibrium that is very sensitive to rapid, and not always predictable, changes from the initial conditions. [37][38][39][40][41][42][43][44][45][46] In accordance with this argument, the analysis of evolutionary instability is essential to understand the model of palliative complexity.…”

Section: Is There Functional Impairment?mentioning

confidence: 99%

“…A recent review of the literature identified 6 models of classification of the complexity of PC needs, aimed at managing referral and shared care with the specialized EPC teams ((Hex-Com, Perroca-Scale, AN-SNAP, Hui-Major-Criteria, IDC-Pal, PALCOM). [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] The use of these tools allows the complexity of PC needs to be categorized as low, in which basic PC would be indicated (primary or secondary PC) or medium-high, in which care by specialized EPC teams would be systematically indicated (tertiary PC).…”

Section: Introductionmentioning

confidence: 99%

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Evolution of Complexity of Palliative Care Needs and Patient Profiles according to the PALCOM Scale: Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients

Tuca,

Viladot,

Carrera

et al. 2024

Preprint

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Introduction: Identifying the complexity of palliative care needs is a key aspect of referral to specialised multidisciplinary early palliative care (EPC) teams. The PALCOM scale is an instrument consisting of five multidimensional assessment domains, developed in 2018 and validated in 2023, to identify the level of complexity in patients with advanced cancer. Objectives: The main objective of this study was to determine the degree of instability (likelihood of level change or death), health resource consumption and survival of patients according to the level of palliative complexity assigned at the baseline visit during a 6-month follow-up. Method: An observational, prospective, multicentre study was conducted using pooled data from the development and validation cohort of the PALCOM scale. The main outcome variables were: a) instability ratio (IR), defined as the probability of level change or death; b) emergency department visits; c) days of hospitalisation; d) hospital death; e) survival. All variables were analysed monthly according to the level of complexity assigned at the baseline visit. Results: A total of 607 patients with advanced cancer were enrolled. According to the PALCOM scale, 20% of patients were classified as low complexity, 50% as medium and 30% as high complexity. The overall IR was 45% in the low complexity group, 68% in the medium complexity group and 78% in the high complexity group (p

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Section: Discussionmentioning

confidence: 99%

Section: Is There Functional Impairment?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evolution of Complexity of Palliative Care Needs and Patient Profiles according to the PALCOM Scale: Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients

Tuca,

Viladot,

Carrera

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…Different models of classification of the complexity of palliative needs have been developed (Hex-Com, Perroca-Scale, AN-SNAP, Hui-Major-Criteria, IDC-Pal, PALCOM) [ 35 , 35 , 37 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. Most of these tools are based on the consensus of experts who identified the characteristics considered to be of greatest complexity and their posterior validation in cross-sectional or Delphi studies.…”

Section: Discussionmentioning

confidence: 99%

Validation Study of the PALCOM Scale of Complexity of Palliative Care Needs: A Cohort Study in Advanced Cancer Patients

Viladot,

Gallardo-Martínez,

Hernandez-Rodríguez

et al. 2023

Cancers

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Background: In a patient-centred model of care, referral to early palliative care (EPC) depends on both the prognosis and the complexity of care needs. The PALCOM scale is a 5-domain multidimensional assessment tool developed to identify the level of complexity of palliative care needs of cancer patients. The aim of this study was to validate the PALCOM scale. Patient and methods: We conducted a prospective cohort study of cancer patients to compare the PALCOM scale and expert empirical assessment (EA) of the complexity of palliative care needs. The EA had to categorise patients according to their complexity, considering that medium to high levels required priority attention from specialist EPC teams, while those with low levels could be managed by non-specialist teams. Systematically collected multidimensional variables were recorded in an electronic report form and stratified by level of complexity and rating system (PALCOM scale versus EA). The correlation rank (Kendall’s tau test) and accuracy test (F1-score) between the two rating systems were analysed. ROC curve analysis was used to determine the predictive power of the PALCOM scale. Results: A total of 283 advanced cancer patients were included. There were no significant differences in the frequency of the levels of complexity between the EA and the PALCOM scale (low 22.3–23.7%; medium 57.2–59.0%; high 20.5–17.3%). The prevalence of high symptom burden, severe pain, functional impairment, socio-familial risk, existential/spiritual problems, 6-month mortality and in-hospital death was significantly higher (p < 0.001) at the high complexity levels in both scoring systems. Comparative analysis showed a high correlation rank and accuracy between the two scoring systems (Kendall’s tau test 0.81, F1 score 0.84). The predictive ability of the PALCOM scale was confirmed by an area under the curve in the ROC analysis of 0.907 for high and 0.902 for low complexity. Conclusions: In a patient-centred care model, the identification of complexity is a key point to appropriate referral and management of shared care with EPC teams. The PALCOM scale is a high precision tool for determining the level of complexity of palliative care needs.

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“…The intrinsic difficulty of a targeted referral model, which is easy to accept from a theoretical point of view, is that the categorization of the complexity of PC needs is neither agreed upon nor well-defined. A recent review of the literature identified six models of classification of the complexity of PC needs, aimed at managing referral and shared care with the specialized EPC teams (Hex-Com, Perroca-Scale, AN-SNAP, Hui-Major-Criteria, IDC-Pal, PALCOM) [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. The use of these tools allows the complexity of PC needs to be categorized as low, in which basic PC would be indicated (primary or secondary PC) or medium-high, in which care by specialized EPC teams would be systematically indicated (tertiary PC).…”

Section: Introductionmentioning

confidence: 99%

Evolution of Complexity of Palliative Care Needs and Patient Profiles According to the PALCOM Scale (Part Two): Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients

Tuca,

Viladot,

Carrera

et al. 2024

Cancers

View full text Add to dashboard Cite

Introduction: Identifying the complexity of palliative care needs is a key aspect of referral to specialized multidisciplinary early palliative care (EPC) teams. The PALCOM scale is an instrument consisting of five multidimensional assessment domains developed in 2018 and validated in 2023 to identify the level of complexity in patients with advanced cancer. (1) Objectives: The main objective of this study was to determine the degree of instability (likelihood of level change or death), health resource consumption and the survival of patients according to the level of palliative complexity assigned at the baseline visit during a 6-month follow-up. (2) Method: An observational, prospective, multicenter study was conducted using pooled data from the development and validation cohort of the PALCOM scale. The main outcome variables were as follows: (a) instability ratio (IR), defined as the probability of level change or death; (b) emergency department visits; (c) days of hospitalization; (d) hospital death; (e) survival. All the variables were analyzed monthly according to the level of complexity assigned at the baseline visit. (3) Results: A total of 607 patients with advanced cancer were enrolled. According to the PALCOM scale, 20% of patients were classified as low complexity, 50% as medium and 30% as high complexity. The overall IR was 45% in the low complexity group, 68% in the medium complexity group and 78% in the high complexity group (p < 0.001). No significant differences in mean monthly emergency department visits (0.2 visits/ patient/month) were observed between the different levels of complexity. The mean number of days spent in hospital per month was 1.5 in the low complexity group, 1.8 in the medium complexity group and 3.2 in the high complexity group (p < 0.001). The likelihood of in-hospital death was significantly higher in the high complexity group (29%) compared to the medium (16%) and low (8%) complexity groups (p < 0.001). Six-month survival was significantly lower in the high complexity group (24%) compared to the medium (37%) and low (57%) complexity groups (p < 0.001). Conclusion: According to the PALCOM scale, more complex cases are associated with greater instability and use of hospital resources and lower survival. The data also confirm that the PALCOM scale is a consistent and useful tool for describing complexity profiles, targeting referrals to the EPC and managing the intensity of shared care.

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Intra-rater reliability and feasibility of the HexCom advanced disease complexity assessment model

Cited by 6 publications

References 22 publications

Evolution of Complexity of Palliative Care Needs and Patient Profiles according to the PALCOM Scale: Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients

Evolution of Complexity of Palliative Care Needs and Patient Profiles according to the PALCOM Scale: Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients

Validation Study of the PALCOM Scale of Complexity of Palliative Care Needs: A Cohort Study in Advanced Cancer Patients

Evolution of Complexity of Palliative Care Needs and Patient Profiles According to the PALCOM Scale (Part Two): Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients

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