Symptom Burden and Palliative Care Among Patients with Multi-Morbidity (S746)

Abstract

•Identify patient-level predictors of high symptom burden.•Describe strategies to implement and evaluate standardization of symptom assessment and management protocols in primary care settings. Palliative care research has largely focused on patients with disease specific conditions. As patients age, they often accumulate diseases that increase their risk of death that is not attributable to a single condition. We assessed symptom burden and quality of life among patients with >3 chronic conditions to determine whether patients receive assessment and treatment consistent with palliation of symptoms. We hypothesized a higher number of comorbidities would be associated with greater symptom burden and poorer quality of life. We identified patients at high risk of hospitalization or death using a prognostic model. We administered cross-sectional surveys (Memorial Symptom Assessment Scale and Veterans-Rand 12) to randomly selected patients enrolled in primary care clinics in the VA Health Care System from May-December 2015. We asked patients if their most bothersome symptom was addressed and being treated during their recent appointment. Regression models identified patient-level predictors of high symptom burden and poor self-perceived health status. Patients (n=503) were white (74%), males (97%), aged 71+11.2 years. Patients reported 10.6+5.5 active symptoms and poor quality of life (28.6+11.4) (physical component scale 0-100, higher score=better health). Pain and dyspnea were the most burdensome symptoms (n=145, 29%; n=57, 11%) respectively. Among patients, 348 (74%) perceived their clinician assessed their most bothersome symptom and 330 (70%) reported they were receiving treatment for it. Younger patients (p=0.01) and those with a greater number of multi-morbidities (p<0.001) reported higher symptom burden than older patients and those with fewer multi-morbidities. Younger patients (p=0.002) and those with a greater number of multi-morbidities (p<0.001) perceived themselves as having worse physical health than older patients and those with fewer multi-morbidities. Our findings support standardization of symptom assessment and management in primary care settings for patients with multi-morbidities. Ameliorating symptoms may result in patients’ higher perceived quality of life.