The challenges of symptom management for patients with multimorbidity in research and practice: A thematic review

Abstract

Introduction: Multimorbidity, the presence of multiple coexisting diseases or conditions, afflicts the majority of older adults, and is associated with increased mortality and healthcare utilization. In addition, multimorbidity negatively impacts quality of life and increases symptom burden. Yet, there is a dearth of evidence on how to best manage symptoms in patients with multimorbidity.

Methods: We conducted a thematic review of approaches to symptom management in multimorbidity.

Results: Research in this area has been hampered by inconsistent definitions of multimorbidity and challenges in outcome measurement. Investigations of symptom management strategies in specific disease states, like cancer, typically exclude medically complex patients. In the absence of evidence, the American Geriatrics Society's recommendations for the care of adults with multimorbidity provide a useful starting point for clinicians. We present a case to demonstrate how the AGS recommendations can be tailored to the situation of symptom management in patients with multimorbidity. We also present suggestions for future research directions.

Discussion: Multimorbidity is an incredibly common and overlooked problem in our healthcare system, and only stands to increase in relevance as patients live longer and have the opportunity to accrue a greater burden of chronic illness. A comprehensive approach to patients with multimorbidity includes focusing on patient preferences, carefully interpreting the available evidence (including both the benefits and potential harms), and thinking critically about the burden of any treatment. Taking time to elicit patient goals and preferences, and apprise patients of their prognosis if they want to know, are especially important in symptom management discussions with patients with multimorbidity.

Keywords:

• Multimorbidity
• Symptom management
• Palliative care

Disclaimer statement

Contributors Christine Ritchie and Laura Petrillo conceived the paper's theme and design. Laura Petrillo drafted the article and Christine Ritchie critically revised it for intellectual content. Both authors reviewed and approved the final version for publication.

Funding Laura Petrillo: Veterans Affairs Quality Scholars Fellowship. Christine Ritchie: National Institute of Nursing Research, Agency for Healthcare Research and Quality, Commonwealth Fund, Retirement Research Foundation, California Healthcare Foundation, Tideswell at UCSF.

Conflict of interest Christine Ritchie: Editor for UptoDate and President, American Academy of Hospice and Palliative Medicine.

Ethics approval This paper is a review, not a study, therefore no ethical approval was sought.