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Symptom Burden and Palliative Care Needs Among High-Risk Veterans With Multimorbidity
- Source :
- Journal of pain and symptom management. 57(5)
- Publication Year :
- 2018
-
Abstract
- Palliative care research has focused on patients with disease-specific conditions. However, older patients with multimorbidity may have unmet palliative care needs.We assessed symptom burden and quality of life among veterans with multimorbidity and sought to determine if their bothersome symptoms were addressed and treated in the primary care setting. We sought to identify specific diagnoses that may account for greater symptom burden. We hypothesized that patients with a higher number of diagnoses would experience greater symptom burden and poorer quality of life.We identified veterans at high risk of hospitalization or death using a validated prognostic model. We administered cross-sectional surveys via telephone, The Memorial Symptom Assessment Scale-Short Form and Veterans RAND 12, to randomly selected patients in primary care in the VA Health Care System from May to December 2015. We assessed if their most bothersome symptom was addressed and treated during their most recent visit. Regression models identified specific diagnoses accounting for greater symptom burden and patient predictors of high symptom burden and poor quality of life.Patients (n = 503) reported (10.6 ± 5.5) active symptoms and poor physical quality of life. Patients reported pain and dyspnea as their most bothersome symptoms (n = 145 [29%] and n = 57 [11%], respectively). Most patients acknowledged their clinicians assessed (n = 348 [74%]) and treated (n = 330 [70%]) their most bothersome symptom. Physical symptoms (78%, P0.0001) were more likely to be addressed than psychological symptoms (55%, P0.001). Patients diagnosed with obesity or depression experienced greater physical symptom burden. Younger patients reported greater symptom severity than older patients (P0.01). Younger patients and those with greater multimorbidities reported lower self-perceived quality of health than older patients and those with fewer multimorbidities (P = 0.01 and P0.01, respectively).Outpatients with multimorbidity have high symptom burden, unaddressed symptoms, poor quality of life, and unmet palliative care needs. Our findings support standardization of comprehensive symptom assessment and management in primary care for veterans with multimorbidities, which may ameliorate symptoms and improve quality of life.
- Subjects :
- Adult
Male
medicine.medical_specialty
Palliative care
Context (language use)
Symptom assessment
Interviews as Topic
03 medical and health sciences
0302 clinical medicine
Quality of life (healthcare)
Cost of Illness
Health care
Ambulatory Care
Medicine
Multimorbidity
Humans
030212 general & internal medicine
Medical diagnosis
General Nursing
Aged
Veterans
Aged, 80 and over
Primary Health Care
business.industry
Palliative Care
Symptom burden
Age Factors
Middle Aged
Anesthesiology and Pain Medicine
Cross-Sectional Studies
030220 oncology & carcinogenesis
Emergency medicine
Quality of Life
Female
Neurology (clinical)
Self Report
business
Subjects
Details
- ISSN :
- 18736513
- Volume :
- 57
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of pain and symptom management
- Accession number :
- edsair.doi.dedup.....d598b392979f4ebca25aace97d3674f8