Illness Trajectories
Three Typical Illness Trajectories for Progressive Chronic Illness:
- Cancer (Short Decline):
- Steady progression with slight decline over months to years.
- Periods of positive or negative effects from cancer treatment.
- Short period of evident decline with increasing symptoms and rapid decline in weight and functional status in the last weeks or months of life.
- Organ Failure (Intermediate with Acute Episodes):
- Typical in non-malignant, life-limiting illnesses like advanced heart or lung disease.
- Intermediate rate of decline over years with long-term limitations.
- Acute, life-threatening exacerbations requiring hospital treatment, followed by further deterioration.
- Death often seems sudden and can occur at any time along the trajectory, with symptoms of end-stage organ failure.
- Frailty or Dementia (Gradual Dwindling):
- Gradual decline of physical and/or cognitive function.
- Long, variable disease course (6-8 years) with early impairment of memory and reduced capacity for decision-making and communication.
- Steady, slow decline in overall function, particularly in the last year of life.
- Frailty and dementia together predict a more rapid decline.
Associated Domains of Illness Trajectories:
- Physical
- Psychological
- Social
- Spiritual/Existential
Factors Altering Illness Trajectories:
- Multimorbidity
- Polypharmacy
- Patient’s wishes and directives
Impact on Clinical Care Planning:
- Discussion of likely disease trajectory helps in:
- Clarifying goals of care and treatment preferences.
- Improving quality of life and symptom control.
- Reducing distress.
- Planning for a good death, including preferred place of death.
- Avoiding unwanted hospital admission.
- Contributing to informed decision making and care delivery (at home, RACF, or hospital).
Figure 1: (Hypothetical as it’s mentioned but not provided)
- Illustrates typical illness trajectories for chronic conditions.
- Juxtaposes phases of palliative care towards the end of life.
Summary
Understanding these illness trajectories and their associated domains helps in providing tailored palliative care, enhancing patient and carer satisfaction, and ensuring a more coordinated approach to end-of-life care.