title: Identifying patients with advanced chronic conditions for a progressive palliative care approach: a cross-sectional study of prognostic indicators related to end-of-life trajectories.
abstract: 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues.
  
  
  
  3 primary care services, an acute care hospital, an intermediate care centre and 4 nursing homes in a mixed urban-rural district in Barcelona, Spain.
  
  
  
  782 patients (61.5% women) with a positive NECPAL CCOMS-ICO test, indicating they might benefit from a PC approach.
  
  
  
  The characteristics and distribution of the indicators of the NECPAL CCOMS-ICO tool are analysed with respect to the 3 trajectories and have been arranged by domain (functional, nutritional and cognitive status, emotional problems, geriatric syndromes, social vulnerability and others) and according to their static (severity) and dynamic (progression) properties.
  
  
  
  The common indicators associated with early end-of-life identification are functional (44.3%) and nutritional (30.7%) progression, emotional distress (21.9%) and geriatric syndromes (15.7% delirium, 11.2% falls). The rest of the indicators showed differences in the associations per illness trajectories (p<0.05). 48.2% of the total cohort was identified as advanced frailty patients with no advanced disease criteria.
  
  
  
  Dynamic indicators are present in the 3 trajectories and are especially useful to identify PACC for a progressive PC approach purpose. Most of the other indicators are typically associated with a specific trajectory. These findings can help clinicians improve the identification of patients for a palliative approach.
authors.affiliation: Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu/Hospital Universitari de Vic, Barcelona, Spain Department of Palliative Care, University of Vic, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Amblàs-Novellas
authors.affiliation: St Columba's Hospice Chair of Primary Palliative Care, Primary Palliative Care Research Group, The Usher Institute, University of Edinburgh, Edinburgh, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Murray
authors.affiliation: Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu/Hospital Universitari de Vic, Barcelona, Spain Department of Palliative Care, University of Vic, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Espaulella
authors.affiliation: Data Analysis and Modeling Research Group, Department of Economics and Business, University of Vic, Barcelona, Spain.
authors.forename: J C
authors.identifier: 0000-0002-8400-5487
authors.initials: JC
authors.lastname: Martori
authors.affiliation: Data Analysis and Modeling Research Group, Department of Economics and Business, University of Vic, Barcelona, Spain.
authors.forename: R
authors.identifier: 0000-0002-4333-0021
authors.initials: R
authors.lastname: Oller
authors.affiliation: Unit of Research Management, Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Martinez-Muñoz
authors.affiliation: Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu/Hospital Universitari de Vic, Barcelona, Spain Department of Palliative Care, University of Vic, Barcelona, Spain.
authors.forename: N
authors.identifier: 0000-0003-0138-6278
authors.initials: N
authors.lastname: Molist
authors.affiliation: Department of Palliative Care, University of Vic, Barcelona, Spain Programme for the Prevention and Care of Patients with Chronic Conditions, Department of Health, Government of Catalonia, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Blay
authors.affiliation: Department of Palliative Care, University of Vic, Barcelona, Spain The Qualy Observatory, WHO Collaborating Centre for Palliative Care Public Health Programs (WHOCC), Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Gómez-Batiste
mesh_terms: D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D012720:Severity of Illness Index; D013030:Spain; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*
keywords: Advanced Frailty; Advanced chronic conditions; End-of-life trajectories; Health Status Indicators; Prognosis