Latent Class Analysis of Symptom Burden Among Seriously Ill Adults at the End of Life.

The analysis was cross-sectional and used baseline data from a specific palliative-care population with a prognosis of 6 months or less, so it may not apply to all seriously ill adults. The original trial excluded people with active cardiovascular disease requiring a statin or a recent cardiovascular event, a group that may have had symptoms. The authors could not adjust for all possible confounders, including health care use or the type, duration, and frequency of palliative care. The Edmonton Symptom Assessment Scale may not have captured all symptoms important to these patients. The analysis used 287 of the 381 eligible participants from the original trial, because only those with baseline symptom data were included. The age and education findings may reflect unmeasured confounding, chance, or underreporting, because the authors note these possibilities.

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Do not read the lower odds of high symptom burden in adults over 75 as evidence that they need less symptom management. This is a cross-sectional association analysis, and the authors note older adults may underreport or minimize symptoms.