Multiple Chronic Conditions among Seriously Ill Adults Receiving Palliative Care

Murali, Komal Patel; Yu, Gary; Merriman, John D.; Vorderstrasse, Allison; Kelley, Amy S.; Brody, Abraham A.

doi:10.1177/01939459211041174

Cited by 4 publications

(6 citation statements)

References 29 publications

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“…8 Within the USA, palliative medicine and nursing organisations have focused on identifying and evaluating potential benchmark indicators of access to and quality of PC services. [14][15][16] In the USA Australia and South Africa, methods of predicting death within 12 months have been evaluated as potential triggers for PC referral and access metrics. 8 17 18 Screening tools, such as the Supportive and Palliative Care Indicators Tool, have been developed to identify patients who might benefit from PC services.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

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Unmet palliative care service needs: a patient-centred metric

Safabakhsh

Lippe

Govahi

et al. 2023

BMJ Support Palliat Care

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ObjectivesFinancial pressures and competing demands for limited resources highlight the importance of defining the unmet need for specialty inpatient palliative care (PC), demonstrating the value of the service line and making decisions about staffing. One measure of access to specialty PC is penetration, the percentage of hospitalised adults receiving PC consultations. Although useful, additional means of quantifying programme performance are required for evaluating access by patients who would benefit. The study sought to define a simplified method of calculating unmet need for inpatient PC.MethodsThis retrospective observational study analysed electronic health records from six hospitals in one health system in Los Angeles County.Unmet need for PC was defined by the number of hospitalised patients with four or more chronic serious comorbidities without a PC consultation divided by a denominator of all patients with one or more chronic serious conditions (CSCs) without a PC during the hospitalisation.ResultsThis calculation identified a subset of patients with four or more CSCs that accounts for 10.3% of the population of adults with one or more CSCs who did not receive PC services during a hospitalisation (unmet need). Monthly internal reporting of this metric led to significant PC programme expansion with an increase in average penetration for the six hospitals from 5.9% in 2017 to 11.2% in 2021.ConclusionsHealth system leadership can benefit from quantifying the need for specialty PC among seriously ill inpatients. This anticipated measure of unmet need is a quality indicator that complements existing metrics.

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Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

“…Hospitals have been encouraged to proactively identify patients who would benefit from specialised PC services and capture data about unmet needs 8. Within the USA, palliative medicine and nursing organisations have focused on identifying and evaluating potential benchmark indicators of access to and quality of PC services 14–168 17 18…”

Section: Introductionmentioning

confidence: 99%

Unmet palliative care service needs: a patient-centred metric

Safabakhsh

Lippe

Govahi

et al. 2023

BMJ Support Palliat Care

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“…Murali et al (2021a) used this framework to guide a study that conducted latent class analysis of symptom burden in seriously ill adults at the end-of-life. In addition, Murali et al (2021b) conducted another latent class analysis to characterize multiple chronic conditions in seriously ill adults at the end-of-life. From these two studies, we can conclude that the framework is applicable for use in end-of-life populations.…”

Section: Contentsmentioning

confidence: 99%

“…One publication (Chukwusa et al, 2019) with the same author (Gao et al, 2018) used this framework as background of the study Yes. One publication (Murali et al, 2021a) and one study under review (Murali et al, 2021b) used this framework to generate research questions…”

Section: Comparison and Selection Of Conceptual Frameworkmentioning

confidence: 99%

A comparison of conceptual frameworks to examine health inequities in End‐of‐Life care

Kang

Barcelona

2022

Journal of Advanced Nursing

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Aims:To discuss existing conceptual frameworks that can be applied to the examination of health inequities in end-of-life care and related health outcomes. We used the Fawcett and Desanto-Madeya evaluation technique modified by the National Institute on Minority Health and Health Disparities Research Framework to include individual, interpersonal, community, and societal levels of influence.Design: Discussion paper. Data sources:We performed a systematic review of PubMed, CINAHL and Embase for conceptual frameworks of health inequities in end-of-life care and health outcomes published as of February 2022. Implications for nursing:There is a strong need for research that can address multiple factors influencing end-of-life care inequities and health outcomes. To mitigate the complex nature of social determinants of health and structural inequities, researchers, clinicians, educators and administrators should have solid conceptualizations of these multi-level factors. Based on sound and comprehensive frameworks, nurses with interdisciplinary partnerships can promote health equity with a broader health care scope through addressing social determinants of health. Conclusion:We identified and reviewed three frameworks. We concluded all three frameworks have the potential for use in the examination of health inequities in endof-life care and health outcomes. However, the Conceptual Framework of Minority Access to End-of-Life Care was more applicable to diverse studies and settings when adapted to include fundamental characteristics such as sex and gender.Impact: Despite the substantial rise in end-of-life care delivery, health inequities persist in end-of-life care access and utilization. Though some studies have been conducted to promote health equity by addressing social determinants of health, progress is hampered by their complex and multi-faceted nature. Through a concrete conceptual framework, researchers can comprehensively examine multi-level factors influencing health inequities in end-of-life care.No patient or public contribution: This discussion paper focused on reviewing existing evidence.

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“…Palliative care can be useful for managing the clinical complexity of having MCCs through tailored pain and symptom management, medication management, serious illness communication, prognostication, and care coordination, and planning for end-of-life care transitions such as hospice enrollment 10,12 . Incorporating clinical complexity in care paradigms, specifically within nursing care, involves the crucial step of highlighting the needs of individuals with MCCs with and without cancer.…”

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confidence: 99%

Complex Care Needs at the End of Life for Seriously Ill Adults With Multiple Chronic Conditions

Murali

Merriman

et al. 2023

J Hosp Palliat Nurs

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Understanding the complex care needs of seriously ill adults with multiple chronic conditions with and without cancer is critical for the delivery of high-quality serious illness and palliative care at the end of life. The objective of this secondary data analysis of a multisite randomized clinical trial in palliative care was to elucidate the clinical profile and complex care needs of seriously ill adults with multiple chronic conditions and to highlight key differences among those with and without cancer at the end of life. Of the 213 (74.2%) older adults who met criteria for multiple chronic conditions (eg, 2 or more chronic conditions requiring regular care with limitations of daily living), 49% had a diagnosis of cancer. Hospice enrollment was operationalized as an indicator for severity of illness and allowed for the capture of complex care needs of those deemed to be nearing the end of life. Individuals with cancer had complex symptomatology with a higher prevalence of nausea, drowsiness, and poor appetite and end of life and lower hospice enrollment. Individuals with multiple chronic conditions without cancer had lower functional status, greater number of medications, and higher hospice enrollment. The care of seriously ill older adults with multiple chronic conditions requires tailored approaches to improve outcomes and quality of care across health care settings, particularly at the end of life.

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Multiple Chronic Conditions among Seriously Ill Adults Receiving Palliative Care

Cited by 4 publications

References 29 publications

Unmet palliative care service needs: a patient-centred metric

Unmet palliative care service needs: a patient-centred metric

A comparison of conceptual frameworks to examine health inequities in End‐of‐Life care

Complex Care Needs at the End of Life for Seriously Ill Adults With Multiple Chronic Conditions

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