Table 2.

Summary of the classification systems.

Classification system	Classification objectives	Number of items	Patient domain items		Care team domain items	Social domain items	Environmental domain items	Assessment tools used (individual items are described under their specific domain)	Grading
			History and function	Symptoms
HexCom	To distinguish between those with specialist PC needs	18 Items		Severity physical symptoms Emotional state Risk factors of psychological vulnerability Feeling loved Confident facing unknown Coherency of being	Desire for hastened death Resource limitations Managing basic care needs Communication	Family support External support networks Risk for bereavement Emotional state of family	Access to care Financial resources planning for death Ability to manage death in care environment		Three levels – High/Medium/Low complexity. High or medium complexity require community team intervention
Perocca scale	To evaluate the complexity of care provision	13 Items	Mobility Limb movement Feeding Self-care Elimination	Wound or skin issues Altered conscious state	Frequency of observations Education needs Intravenous therapy Communication difficulties Behavioural issues Requiring oxygen				Four levels of complexity – minimal, intermediate, semi-intensive, intensive
AN-SNAP palliative care	To classify casemix in accordance with health resource use	9 Items total	Phase of illness Mobility Toileting Eating Transfers	Pain Other Sx Psychospiritual Sx		Family or carer distress		RUG-ADL PC Problem severity score (PCPSS)	11 Classification for inpatient, 22 for community
Hui major criteria	To determine need for specialist versus general palliative care	11 Items	Poor prognosis Progressive disease despite chemotherapy Brain metastases or leptomeningeal disease Spinal cord compression or cauda equina	Delirium Spiritual or emotional crisis Severe physical Sx Severe emotional Sx	Request for specialist PC Request for hastened death Assistance with decision-making and planning				Two levels – complex (requiring specialist PC) or non-complex (general PC)
IDC-Pal	To diagnose and stratify complexity, and recommends need for specialist PC	36 Items (35 patient items and one item to add up total score)	Paediatric patient Addiction issues Previous disability Mental illness Patient is a health professional Significant social role Abrupt change in functional autonomy	Difficult Sx Refractory Sx, Urgent terminal Sx Difficult to control terminal Sx Progressive clinical situation Decompensated organ failure Severe cognitive Sx Severe constitutional Sx Difficult to Mx comorbidity Suicide risk Inadequate emotional coping Spiritual suffering	Communication conflicts with health care team Request for hastened death Limitations in professional competence Difficulty in coordination of services Non-compliance issues Difficult palliative sedation Difficult medication Mx Difficult interventions	Family communication conflict Family or carer burden Complex bereavement Inadequate family support Lack of carer competence Dysfunctional family	Environmental limitations Difficulty accessing material or techniques		Three levels – Non-complex – no need for specialist PC. – Complex – potential role for spec PC – High complex – spec PC recommended
PALCOM 1	To assess complexity in palliative care, to manage referral to specialised PC services	24 Items	Karnofsky performance status	Mechanism of pain Pain characteristics Previous narcotic use Cognitive function Psychological distress Presence of pain Asthenia Anorexia Nausea & Vomiting Constipation Dyspnoea Somnolence Insomnia Anxiety Depression	Conflict of information Discrepancies regarding proportionality of treatment Loss of desire to remain alive or hasten death Wish for euthanasia	Absence of carer Carer limitations due to physical health Carer limitations due to work obligations Another person in family requiring care Carer overload Conflict within family		Karnofsky Performance scale Edmonton Classification System for Cancer Pain (ECS-CP)	Three levels – Low Complexity, for general PC – Medium Complexity, for specialised PC – High complexity. for specialised PC

PC: Tool – palliative care; Sx: Symptoms; Mx: Management.