Research Priorities in Geriatric Palliative Care: Multimorbidity

Ritchie, Christine S.; Zulman, Donna M.

doi:10.1089/jpm.2013.9491

Cited by 29 publications

(29 citation statements)

References 41 publications

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“…This group of people have previously often been excluded from research due to their frailty and having several interfering chronic diseases (Ritchie and Zulman 2013). To ensure trustworthiness, the concept credibility, conformability, dependability and transferability have to be taken into consideration (Graneheim and Lundman 2004), A few limitations need to be addressed.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity

Eckerblad

Theander

Ekdahl

et al. 2015

Applied Nursing Research

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Context. Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life.Objectives. The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.Method. A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.Results. The experience of living with a high symptom burden revealed the overall theme, "To adjust and endure" and three sub-themes. The first subtheme was "To feel inadequate and limited". Participants reported they no longer had the capacity or the ability to manage and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience, the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone, the only thing left to do was to sit or lie down and wait for it all to pass.Conclusion. This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that it is possible to treat or improve.

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Section: Strengths and Limitationsmentioning

confidence: 99%

To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity

Eckerblad

Theander

Ekdahl

et al. 2015

Applied Nursing Research

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“…[11] Multiple chronic conditions act synergistically to increase difficulties in finding appropriate medications and treatment regimens that work for all conditions. [12] Among patients with advanced cancer and other serious illnesses, aggressive treatments often are inconsistent with patients’ preferences,[13, 14] have limited efficacy,[15, 16] and are associated with worse quality of life, compared to other treatments. [17]…”

mentioning

confidence: 99%

Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities

et al. 2016

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Patients with multiple serious conditions account for a high proportion of health care spending. Such spending is projected to continue to grow substantially because of increased insurance eligibility, the ever-rising cost of care, the continued use of nonbeneficial high-intensity treatments at the end of life, and demographic changes. We evaluated the impact of palliative care consultation on hospital costs for adults with advanced cancer, excluding those with dementia. We found that compared to usual care, the receipt of a palliative care consultation within two days of admission was associated with 22 percent lower costs for patients with a comorbidity score of 2–3 and with 32 percent lower costs for those with a score of 4 or higher. Earlier consultation was also found to be systematically associated with a larger cost-saving effect for all subsamples defined by multimorbidity. Given ongoing workforce shortages, targeting early specialist palliative care to hospitalized patients with advanced cancer and higher numbers of serious concurrent conditions could improve care while complementing strategies to curb the growth of health spending.

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“…Another reason that minimal data exist about patients with multimorbidity is that most research studies that are focused on single diseases exclude patients with significant comorbid conditions 18 . By definition, patients with multimorbidity are complex and diverse, but it is exactly that complexity that is unattractive in research studies, which aim to isolate the effect of one variable, or select a population with the best likelihood of response to a treatment (and lowest likelihood of harm).…”

Section: Challenges In Multimorbidity Symptom Management Researchmentioning

confidence: 99%

“…If available, a very relevant metric for patients with multimorbidity is the time to benefit (or harm) from an intervention 18 . The most classic examples of delayed time to benefit are cancer screening, or preventive medicine like statins for elevated cholesterol or tight glucose management in diabetes.…”

Section: Ideas For Approaching Symptom Management In Patients With Mumentioning

confidence: 99%

“…Future studies might evaluate the comparative effectiveness of symptom treatments in complex patients who might otherwise be excluded from research 18,36 . An idea with potential for studying patients with multimorbidity is the concept of an “N-of-1 trial,” in which treatments are randomly allocated and assessed in a single subject using objective criteria, and the patient serves as his own control 37 .…”

Section: Future Directionsmentioning

confidence: 99%

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The challenges of symptom management for patients with multimorbidity in research and practice: A thematic review

Petrillo

Ritchie

2016

Progress in Palliative Care

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Multimorbidity, the presence of multiple coexisting diseases or conditions, afflicts the majority of older adults, and is associated with increased mortality and healthcare utilization. In addition, multimorbidity negatively impacts quality of life and increases symptom burden. Yet, there is a dearth of evidence on how to best manage symptoms in patients with multimorbidity. Research in this area has been hampered by inconsistent definitions of multimorbidity and challenges in outcome measurement. Investigations of symptom management strategies in specific disease states, like cancer, typically exclude medically complex patients. In the absence of evidence, the American Geriatrics Society’s recommendations for the care of adults with multimorbidity provide a useful starting point for clinicians. We present a case to demonstrate how the AGS recommendations can be tailored to the situation of symptom management in patients with multimorbidity. We also present suggestions for future research directions.

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Research Priorities in Geriatric Palliative Care: Multimorbidity

Cited by 29 publications

References 41 publications

To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity

To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity

Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities

The challenges of symptom management for patients with multimorbidity in research and practice: A thematic review

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