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.
背景：在以患者为中心的照护模式中，转诊至早期姑息治疗（EPC）既取决于患者预后，也取决于照护需求的复杂程度。PALCOM量表是一种包含五个维度的多维评估工具，旨在识别癌症患者姑息治疗需求的复杂程度。本研究旨在验证PALCOM量表的有效性。患者与方法：我们对癌症患者开展了一项前瞻性队列研究，比较PALCOM量表与专家经验评估（EA）对姑息治疗需求复杂程度的判定结果。经验评估需根据患者复杂程度进行分类，其中中高复杂程度患者需获得专业EPC团队的优先关注，而低复杂程度患者可由非专业团队管理。通过电子报告表系统记录收集的多维变量，并按复杂程度和评估系统（PALCOM量表与经验评估）进行分层。分析两种评估系统间的等级相关性（肯德尔tau检验）与准确性（F1分数），并采用ROC曲线分析确定PALCOM量表的预测效能。结果：共纳入283例晚期癌症患者。经验评估与PALCOM量表判定的复杂程度分布无显著差异（低度22.3%-23.7%；中度57.2%-59.0%；高度20.5%-17.3%）。在两种评估系统中，高复杂程度组均显著更高比例地出现高症状负担、重度疼痛、功能障碍、社会家庭风险、存在性/精神问题、6个月死亡率及院内死亡（p<0.001）。比较分析显示两种评估系统具有高度等级相关性与准确性（肯德尔tau检验0.81，F1分数0.84）。ROC曲线分析显示PALCOM量表对高复杂程度的曲线下面积为0.907，对低复杂程度为0.902，证实了其预测能力。结论：在以患者为中心的照护模式中，复杂程度识别是实现EPC团队合理转诊与协同照护管理的关键环节。PALCOM量表是判定姑息治疗需求复杂程度的高精度工具。
肿瘤(癌症)患者之家