Martin-Rosello Maria Luisa, Sanz-Amores Maria Reyes, Salvador-Comino Maria Rosa
Cudeca Hospice Foundation.
Malaga Biomedical Research Institute (IBIMA), Malaga-Gaudalhorce Health District, University of Malaga, Malaga.
Curr Opin Support Palliat Care. 2018 Dec;12(4):480-488. doi: 10.1097/SPC.0000000000000403.
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.
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.
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.
患有终末期和慢性疾病及合并症的患者数量不断增加，这对任何医疗保健系统而言都是一项挑战，即在生命末期提供有效且高效的以患者为中心的护理。资源有限，患者情况和医疗保健专业人员干预措施的复杂性却在增加。本综述介绍了复杂性在专科姑息治疗提供中的作用的最新情况。
尽管与姑息治疗中的复杂性相关的研究仍然有限，但当前文献中越来越多地出现了关于合并症和姑息治疗中的复杂性框架的有趣综述。它们将多维度问题、资源利用及其之间的关系确定为复杂性结构的基本方面，有助于定义和理解复杂性，从而设计经过验证的工具来支持医疗保健专业人员识别最复杂的患者，例如本综述中介绍的许氏标准、PALCOM、INTERMED和IDC-Pal。
迫切需要确保所有符合姑息治疗条件的患者，从那些需要姑息治疗方法的患者到需要专科强化姑息治疗的患者，都能获得高质量和公平的护理。将复杂性理论付诸实践至关重要。本综述描述了复杂性科学、复杂性框架以及评估姑息治疗中复杂性的工具。
