Viladot Margarita, Gallardo-Martínez Jose-Luís, Hernandez-Rodríguez Fany, Izcara-Cobo Jessica, Majó-LLopart Josep, Peguera-Carré Marta, Russinyol-Fonte Giselle, Saavedra-Cruz Katia, Barrera Carmen, Chicote Manoli, Barreto Tanny-Daniela, Carrera Gemma, Cimerman Jackeline, Font Elena, Grafia Ignacio, Llavata Lucia, Marco-Hernandez Javier, Padrosa Joan, Pascual Anais, Quera Dolors, Zamora-Martínez Carles, Bozzone Ana-Maria, Font Carme, Tuca Albert
Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain.
Home Care Support Teams Program (PADES) Group Mutuam, 08025 Barcelona, Spain.
Cancers (Basel). 2023 Aug 20;15(16):4182. doi: 10.3390/cancers15164182.
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.
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.
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 ( < 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.
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.
在以患者为中心的护理模式中，转诊至早期姑息治疗（EPC）取决于预后和护理需求的复杂性。PALCOM量表是一种五维度的多维度评估工具，旨在确定癌症患者姑息治疗需求的复杂程度。本研究的目的是验证PALCOM量表。
我们对癌症患者进行了一项前瞻性队列研究，以比较PALCOM量表与专家经验评估（EA）对姑息治疗需求复杂性的评估。EA必须根据患者的复杂程度对其进行分类，考虑到中高程度需要专科EPC团队优先关注，而低程度患者可由非专科团队管理。系统收集的多维度变量记录在电子报告表中，并按复杂程度和评分系统（PALCOM量表与EA）进行分层。分析了两种评分系统之间的相关等级（肯德尔tau检验）和准确性检验（F1分数）。采用ROC曲线分析来确定PALCOM量表的预测能力。
共纳入283例晚期癌症患者。EA和PALCOM量表在复杂程度水平的频率上无显著差异（低22.3 - 23.7%；中57.2 - 59.0%；高20.5 - 17.3%）。在两个评分系统中，高复杂程度水平下高症状负担、重度疼痛、功能障碍、社会家庭风险、生存/精神问题、6个月死亡率和院内死亡的患病率均显著更高（<0.001）。比较分析显示，两种评分系统之间具有较高的相关等级和准确性（肯德尔tau检验0.81，F1分数0.84）。ROC分析中，PALCOM量表的预测能力得到证实，高复杂程度的曲线下面积为0.907，低复杂程度的曲线下面积为0.902。
在以患者为中心的护理模式中，确定复杂性是适当转诊以及与EPC团队进行共享护理管理的关键点。PALCOM量表是确定姑息治疗需求复杂程度的高精度工具。
