{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T04:09:28Z","timestamp":1751429368823,"version":"3.41.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The main criterion for the intervention of specialist palliative care is how to balance complexity of needs and prognosis. Appropriate organization and dedicated clinical tools should enable the clinicians and patients to meet this criterion.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We conducted a retrospective observational study on 184 cancer patients referred to a specialized palliative care service. The difference in level of complexity was analyzed using the PALCOM scale assessment tool in regard to referrals from multidisciplinary teams versus wards.<\/jats:p>\n            <jats:p>A specialized palliative care service trained the health professionals of the multidisciplinary teams in 2019 and has been working daily in the hospital since 2013.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The number of referrals to the palliative care service by the wards was more than double the referrals by the multidisciplinary teams, and the level of complexity was 45% for patients referred by wards vs. 10% referred by discussion teams.<\/jats:p>\n            <jats:p>From our results, it seems reasonable to assume that training in complexity tools may increase the number of referrals to the palliative care service, while working alongside the health professionals in the wards leads to an increase in recognizing complex needs and thus better appropriateness of referrals to the palliative care service.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>A hospital-based specialist palliative care service with clinical and training expertise can increase the appropriateness of referrals.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12913-025-12940-1","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T09:16:04Z","timestamp":1751361364000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Difference in the level of complexity assessed on patients with advanced cancer referred to a hospital-based palliative care unit by multidisciplinary teams and wards: a retrospective study"],"prefix":"10.1186","volume":"25","author":[{"given":"Silvia","family":"Tanzi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Peruselli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Alquati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlotta","family":"Pellegri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Sacchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"issue":"13","key":"12940_CR1","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1056\/NEJMp1215620","volume":"368","author":"TE Quill","year":"2013","unstructured":"Quill TE, Abernethy AP. Generalist plus specialist palliative care\u2013creating a more sustainable model. N Engl J Med. 2013;368(13):1173\u20135.","journal-title":"N Engl J Med"},{"issue":"4","key":"12940_CR2","doi-asserted-by":"publisher","first-page":"791","DOI":"10.21037\/apm-22-894","volume":"12","author":"G Cerullo","year":"2023","unstructured":"Cerullo G, Videira-Silva A, Carrancha M, Rego F, Nunes R. Complexity of patient care needs in palliative care: a scoping review. Ann Palliat Med. 2023;12(4):791\u2013802.","journal-title":"Ann Palliat Med"},{"issue":"7","key":"12940_CR3","doi-asserted-by":"publisher","first-page":"1336","DOI":"10.1200\/JCO.2004.12.095","volume":"22","author":"HM Chochinov","year":"2004","unstructured":"Chochinov HM. Dignity and the eye of the beholder. J Clin Oncol. 2004;22(7):1336\u201340.","journal-title":"J Clin Oncol"},{"issue":"4","key":"12940_CR4","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1016\/j.jpainsymman.2020.04.027","volume":"60","author":"L Radbruch","year":"2020","unstructured":"Radbruch L, De Lima L, Knaul F, Wenk R, Ali Z, Bhatnaghar S, et al. Redefining palliative care-A new consensus-based definition. J Pain Symptom Manage. 2020;60(4):754\u201364.","journal-title":"J Pain Symptom Manage"},{"issue":"9","key":"12940_CR5","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1200\/JCO.18.02123","volume":"38","author":"D Hui","year":"2020","unstructured":"Hui D, Bruera E. Models of palliative care delivery for patients with Cancer. J Clin Oncol. 2020;38(9):852\u201365.","journal-title":"J Clin Oncol"},{"issue":"1","key":"12940_CR6","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s12904-022-00968-7","volume":"21","author":"S Tanzi","year":"2022","unstructured":"Tanzi S, Martucci G, Autelitano C, Alquati S, Peruselli C, Artioli G. Consultations\u2019 demand for a hospital palliative care unit: how to increase appropriateness? Implementing and evaluating a multicomponent educational intervention aimed at increase palliative care complexity perception skill. BMC Palliat Care. 2022;21(1):90.","journal-title":"BMC Palliat Care"},{"issue":"5","key":"12940_CR7","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1097\/PPO.0b013e3181f684e5","volume":"16","author":"IJ Higginson","year":"2010","unstructured":"Higginson IJ, Evans CJ. What is the evidence that palliative care teams improve outcomes for cancer patients and their families? Cancer J. 2010;16(5):423\u201335.","journal-title":"Cancer J"},{"issue":"7","key":"12940_CR8","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1007\/s00520-023-07912-2","volume":"31","author":"H Hirayama","year":"2023","unstructured":"Hirayama H, Satomi E, Kizawa Y, Miyazaki M, Tagami K, Sekine R, et al. The effect of palliative care team intervention and symptom improvement using patient-reported outcomes: a multicenter prospective observational study. Support Care Cancer. 2023;31(7):439.","journal-title":"Support Care Cancer"},{"issue":"9","key":"12940_CR9","first-page":"CD012780","volume":"9","author":"S Bajwah","year":"2020","unstructured":"Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, et al. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2020;9(9):CD012780.","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"12940_CR10","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/s00520-017-3840-3","volume":"26","author":"A Tuca","year":"2018","unstructured":"Tuca A, G\u00f3mez-Mart\u00ednez M, Prat A. Predictive model of complexity in early palliative care: a cohort of advanced cancer patients (PALCOM study). Support Care Cancer. 2018;26(1):241\u20139.","journal-title":"Support Care Cancer"},{"issue":"1","key":"12940_CR11","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12904-019-0476-8","volume":"18","author":"G Artioli","year":"2019","unstructured":"Artioli G, Bedini G, Bertocchi E, Ghirotto L, Cavuto S, Costantini M, et al. Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation. BMC Palliat Care. 2019;18(1):88.","journal-title":"BMC Palliat Care"},{"issue":"9","key":"12940_CR12","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1177\/0269216320947289","volume":"34","author":"S Tanzi","year":"2020","unstructured":"Tanzi S, Alquati S, Martucci G, De Panfilis L. Learning a palliative care approach during the COVID-19 pandemic: a case study in an infectious diseases unit. Palliat Med. 2020;34(9):1220\u20137.","journal-title":"Palliat Med"},{"issue":"1","key":"12940_CR13","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1186\/s12909-020-02275-2","volume":"20","author":"S Tanzi","year":"2020","unstructured":"Tanzi S, De Panfilis L, Costantini M, Artioli G, Alquati S, Di Leo S. Development and preliminary evaluation of a communication skills training programme for hospital physicians by a specialized palliative care service: the \u2018teach to talk\u2019 programme. BMC Med Educ. 2020;20(1):363.","journal-title":"BMC Med Educ"},{"issue":"1","key":"12940_CR14","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1177\/0300891619869513","volume":"106","author":"S Tanzi","year":"2020","unstructured":"Tanzi S, Leo SD, Mazzini E, Castagnetti M, Turr\u00e0 C, Peruselli C, et al. Long-term sustainability of a quality improvement program on cancer pain management: a complex intervention in an inpatient setting. Tumori. 2020;106(1):25\u201332.","journal-title":"Tumori"},{"key":"12940_CR15","doi-asserted-by":"crossref","unstructured":"Carrasco-Zafra MI, G\u00f3mez-Garc\u00eda R, Oca\u00f1a-Riola R, Mart\u00edn-Rosell\u00f3 ML, Blanco-Reina E. Level of palliative care complexity in advanced cancer patients: a multinomial logistic analysis. J Clin Med. 2020;9(6):1960:1\u201312.","DOI":"10.3390\/jcm9061960"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12940-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-025-12940-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12940-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T09:16:06Z","timestamp":1751361366000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-025-12940-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["12940"],"URL":"https:\/\/doi.org\/10.1186\/s12913-025-12940-1","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,1]]},"assertion":[{"value":"25 September 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Ethics Committee Area Vasta Emilia Romagna Nord (AVEN) (Protocol n. 2018\/0008418, January 23, 2018). All participants provided a signed informed consent form to participate in the study. All methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"842"}}