What links multimorbidity and palliative care?

16 Jan

by Rebecca Hays, Research Associate for the Multimorbidity theme

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In November 2013, Peter Bower (Theme Lead), Gavin Daker-White (Research Fellow) and I visited the Primary Palliative Care Research Group (PPCRG) at the University of Edinburgh. The goal of palliative care is to provide the best possible quality of life for patients approaching the end of life, and their families, through physical, psychological, social and spiritual support to prevent and relieve suffering. The PPCRG aim to extend palliative care so it starts earlier, is provided for more life-threatening illnesses, and can be delivered in all community settings.

One study carried out by the PPCRG, with colleagues from King’s College London, the University of Warwick and the University of Cambridge, concerned the co-ordination of care for people at risk of dying. In this study, researchers observed the work of healthcare providers in different care settings, including their consultations with patients. The research team also interviewed patients in the last 12 months of life, their carers and healthcare providers, and followed them up for 9 months.

We will use similar methods in the ‘MAXimising Involvement in MUltiMorbidity (MAXIMUM) in Primary Care’ study. Over the next two years, we will observe interactions between patients and their care providers, and interview them to learn more about the care of people with multimorbidity. Through these methods, we will explore the ways in which multimorbidity can lead to safety problems in primary care, and how patients, carers and healthcare providers respond to potential safety issues.

During our visit, we discussed the overlap between people with multimorbidity and those in the last 12 months of life, who are eligible for palliative care. Multimorbidity was an unexpected focus of the PPCRG’s co-ordination of care study, and the research team are now revisiting data they collected on multiple conditions and patient perspectives of illness. Patients’ views on their health can be affected by a number of things, including how many medications they take and how well they are able to manage their co-occurring symptoms and conditions.

Managing care can be difficult for people with Multimorbidity and those at risk of dying. There may be communication problems between patients and healthcare providers, and it can be challenging to co-ordinate the care provided by different services. During our meeting, researchers from the PPCRG emphasised the important role informal carers play in supporting their family members. Through our work, we hope to identify opportunities for both patients and carers to become more involved in their care, and minimise safety failures.

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