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What are the main palliative care symptoms and concerns of older people with multimorbidity?—a comparative cross-sectional study using routinely collected Phase of Illness, Australia-modified Karnofsky Performance Status and Integrated Palliative Care Outcome Scale data

Nicholson, Caroline; Davies, Joanna M.; George, Rob; Smith, Blake; Pace, Victor; Harris, Laura; Ross, Joy; Noble, Jan; Hansford, Penny; Murtagh, Fliss E.M.

Authors

Caroline Nicholson

Joanna M. Davies

Rob George

Blake Smith

Victor Pace

Laura Harris

Joy Ross

Jan Noble

Penny Hansford



Abstract

BACKGROUND: Older people with multimorbidities are projected to be the main recipients of palliative care in the coming decades. However, because their specific palliative care needs are poorly understood and service response is underdeveloped, older people with multimorbidity are less likely to receive palliative care. Innovative specialist palliative care services are developing to address this gap, but with little underpinning evidence. Therefore the aim of this paper is to describe the clinical characteristics, symptoms and other concerns of older people with multi-morbidity referred to a new community palliative care service; and to explore possible implications for service delivery by comparing this service population with people receiving standard community-based specialist palliative care. METHODS: Cross-sectional study comparing routinely collected demographic, clinical, and point-of-care patient-level outcomes data [Phase of Illness, Australia-modified Karnofsky Performance Status (AKPS) and Integrated Palliative care Outcome Scale] across an innovative palliative service-Bromley Care Coordination (BCC) with patients in the standard specialist community palliative care (SC). Composite case studies of BCC patients provide more in-depth illustration of results. RESULTS: Compared with patients who received Standard Care, patients seen by BCC were more often female, older and with a non-malignant diagnosis (16% cancer in BCC versus 72% cancer in SC). Patients across the two services had a similar symptom profile at first contact in the pairwise complete case analysis. SC patients reported more frequently pain, nausea, vomiting, constipation, anxiety and family concern, and BCC patients reported more frequently mobility concerns. Functional status was lower for BCC patients on entry into the service (AKPS 40 median versus SC AKPS of 50). BCC patients stayed longer in each phase of illness (56 days median versus SC 41 days), with a more unpredictable subsequent phase. CONCLUSIONS: The population of older people with multimorbidity has not been routinely recognized as having specialist palliative care needs. However, this evaluation shows that, at first contact, the symptoms and concerns across both service populations was surprisingly similar. Nevertheless, patterns of symptoms may differ between populations over time. Longitudinal prospective data are needed to examine these changes overtime, and the relationship with multimorbidity.

Citation

Nicholson, C., Davies, J. M., George, R., Smith, B., Pace, V., Harris, L., Ross, J., Noble, J., Hansford, P., & Murtagh, F. E. (2018). What are the main palliative care symptoms and concerns of older people with multimorbidity?—a comparative cross-sectional study using routinely collected Phase of Illness, Australia-modified Karnofsky Performance Status and Integrated Palliative Care Outcome Scale data. Annals of palliative medicine, 7(Supplement 3), S164-S175. https://doi.org/10.21037/apm.2018.06.07

Journal Article Type Article
Acceptance Date Jun 14, 2018
Online Publication Date Jul 18, 2018
Publication Date Oct 1, 2018
Deposit Date Jan 8, 2019
Journal Annals of palliative medicine
Print ISSN 2224-5820
Peer Reviewed Peer Reviewed
Volume 7
Issue Supplement 3
Pages S164-S175
DOI https://doi.org/10.21037/apm.2018.06.07
Keywords Multimorbidity; frailty; older people palliative care; patient reported outcome measures
Public URL https://hull-repository.worktribe.com/output/934669
Publisher URL http://apm.amegroups.com/article/view/20402/21257