Multiple Chronic Conditions among Seriously Ill Adults Receiving Palliative Care.
Komal P Murali, Gary Yu, John D Merriman and 3 others
PMID 34433344WHAT IT FOUND
Among palliative-care patients with multiple chronic conditions, three condition patterns appeared: moderate burden with mixed conditions, high burden with mixed conditions, and high burden with metastatic cancer.
The moderate-burden group had more shortness of breath, lower function, and more dementia.
Key findings
01The analysis found three groups: low-to-moderate condition burden with multiple chronic conditions, high burden with multiple chronic conditions, and high burden with metastatic cancer.
02The low-to-moderate condition burden group had 101 people over age 75, the most in any group, and the greatest number with cognitive impairment or dementia; it also had frequent shortness of breath and lower functional status.
03The high condition burden metastatic cancer group had higher function than the multiple-chronic-condition groups, with 56% scoring 60 or higher on a functional status scale.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis used baseline data only, so it cannot show that any group or care approach caused outcomes. Participants all had serious illness with prognosis of 6 months or less and were on statins, so findings may not apply to other palliative-care patients. Recent cardiovascular accident requiring statins was excluded from the parent trial, potentially leaving out a major comorbidity. The grouping used only the Charlson comorbidity index and unspecified other diagnoses, so it may not capture the full condition burden. Symptom and quality-of-life data were missing for 97 participants. The sample was mostly non-Hispanic White (80.6%) and covered by Medicare or Medicaid, limiting generalizability. Quality of life and symptom scores were divided into quartiles because clinically meaningful cut points were not available, so their practical meaning is uncertain.
Declared interests
NIH extramural research support is listed. No author conflict-of-interest statement is reported.
The easy way to misread this
Do not read these subgroups as tested care pathways or proof that treating one condition will improve outcomes. The analysis only described comorbidity patterns and associations at baseline in a palliative-care sample.