Introduction Complex needs for palliative care patients are not well defined, yet clarity is necessary to meet the needs of patients and their families in all settings, round the clock.

Aim To explore professionals’ understandings of patient complexity in palliative care across 3 settings.

Methods We triangulated the findings from 3 qualitative studies. Semi-structured interviews were conducted with professionals from primary, specialist palliative and acute care. Interviews were audio-recorded, transcribed, coded thematically and analysed by each study researcher, independently. Emerging themes were then discussed as a team and a framework was devised to comprehensively collate, compare and contrast all three sets of results.

Results Thirty-four interviews were conducted across the 3 settings. A number of themes spanned all three settings. The interaction between diverse physical, psychosocial and spiritual needs, existing co-morbidities, intractable symptoms and complicated social issues exacerbated patient complexity, particularly for primary care professionals ‘out of hours’. Poor communication was highlighted, particularly between generalists and specialists, although primary care professionals highlighted the potential of electronic care summaries. Generalists felt they lacked skill in identifying and caring for complex patients and time for professional development in palliative care.

Conclusion Patient complexity is influenced by patient factors but also environmental factors, specific to each setting. Better communication between disciplines could improve the care of patients outside normal working hours. A clear definition of complexity will improve the identification of patients for specialist palliative care, which has implications for resource allocation across all settings.

References

1. Grant RW, Ashburner JM, Clemens CH, et al. Defining Patient Complexity from the Primary Care Physician’s Perspective. Ann Intern Med 2011;155:797–804

2. Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting a consensus report from the to advance palliative care. J Palliat Med 2011;14(1):1723