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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

Research output: Contribution to journalArticle

Standard

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.

In: Annals of Palliative Medicine, Vol. 7, No. 3, 01.10.2018, p. S164-S175.

Research output: Contribution to journalArticle

Harvard

Nicholson, C, Davies, JM, George, R, Smith, B, Pace, V, Harris, L, Ross, J, Noble, J, Hansford, P & Murtagh, FEM 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, vol. 7, no. 3, pp. S164-S175. https://doi.org/10.21037/apm.2018.06.07

APA

Nicholson, C., Davies, J. M., George, R., Smith, B., Pace, V., Harris, L., ... Murtagh, F. E. M. (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(3), S164-S175. https://doi.org/10.21037/apm.2018.06.07

Vancouver

Nicholson C, Davies JM, George R, Smith B, Pace V, Harris L et al. 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. 2018 Oct 1;7(3):S164-S175. https://doi.org/10.21037/apm.2018.06.07

Author

Nicholson, Caroline ; Davies, Joanna M. ; George, Rob ; Smith, Blake ; Pace, Victor ; Harris, Laura ; Ross, Joy ; Noble, Jan ; Hansford, Penny ; Murtagh, Fliss E.M. / 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. In: Annals of Palliative Medicine. 2018 ; Vol. 7, No. 3. pp. S164-S175.

Bibtex Download

@article{83541c0116b14f3c975151c5ca9f77b5,
title = "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",
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.",
keywords = "frailty, Multimorbidity, older people palliative care, patient reported outcome measures",
author = "Caroline Nicholson and Davies, {Joanna M.} and Rob George and Blake Smith and Victor Pace and Laura Harris and Joy Ross and Jan Noble and Penny Hansford and Murtagh, {Fliss E.M.}",
year = "2018",
month = "10",
day = "1",
doi = "10.21037/apm.2018.06.07",
language = "English",
volume = "7",
pages = "S164--S175",
journal = "Annals of Palliative Medicine",
issn = "2224-5820",
publisher = "AME Publishing Company",
number = "3",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - 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

AU - Nicholson, Caroline

AU - Davies, Joanna M.

AU - George, Rob

AU - Smith, Blake

AU - Pace, Victor

AU - Harris, Laura

AU - Ross, Joy

AU - Noble, Jan

AU - Hansford, Penny

AU - Murtagh, Fliss E.M.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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.

AB - 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.

KW - frailty

KW - Multimorbidity

KW - older people palliative care

KW - patient reported outcome measures

UR - http://www.scopus.com/inward/record.url?scp=85055075865&partnerID=8YFLogxK

U2 - 10.21037/apm.2018.06.07

DO - 10.21037/apm.2018.06.07

M3 - Article

C2 - 30180731

AN - SCOPUS:85055075865

VL - 7

SP - S164-S175

JO - Annals of Palliative Medicine

JF - Annals of Palliative Medicine

SN - 2224-5820

IS - 3

ER -

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