Aim To evaluate factors perceived as contributing to patient complexity in a community specialist palliative care team (SPCT) and assess confidence of community staff in identifying and managing such patients.
Background Multiple co-morbidities, increased healthcare usage and psychosocial vulnerabilities feature broadly in descriptions of complexity and are prevalent within the palliative care demographic. Shared awareness of more-complex patients is necessary for cohesive care, effective handover and learning. Despite this, it is unclear how confidently SPCTs identify and manage such patients.
Methods 14 nurses, HCAs and AHPs in a mixed-experience community SPCT in North East England were surveyed. Participants scored different biopsychosocial-spiritual aspects on a scale of 1 to 5 according to perceived contribution to complexity (1=weak and 5=strong contribution). Scores for each aspect were totaled. Participants then self-rated agreement with statements around complex patient identification, management and team support. Percentages of respondents self-rating >6/10 were calculated.
Results 23.7% of patients were rated more complex than average. Exhausting clinical management options and high symptom burden contributed most to complexity (aggregated score 65/70), followed by rapid condition changes (64/70) and requirement for frequent interventions/admissions (63/70). 57.1% of staff felt at least somewhat confident in identifying and managing complex patients, with only 35.7% aware of robust systems for flagging complex individuals. 78.6% agreed a formalised system (e.g. ‘Virtual Ward’) could improve complex patient care.
Discussion Self-perceived influencers of complexity are congruent with the literature, yet confidence in identifying and managing such patients is low. Subgroup analysis shows that although more-experienced staff have greater confidence in managing complexity, they perceive fewer opportunities to flag and discuss complex individuals, highlighting the need for a cross-sectional approach to enhancing complex patient care. Findings will help develop criteria to objectively and proactively define complex patients and improve care through greater team collaboration.
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