title: Advanced serious illness, multimorbidity, and multibeneficence: The role of communication.
abstract: Sturmberg et al write about multimorbidity as "several diagnosable diseases within the same individual." They posit that this syndrome is the result of multiple interconnected disturbances reflecting scale-free, fractal signs of pathology ranging from biochemical/hormonal alterations at one end of a spectrum to community and societal ills at the other. In this commentary, I will be focusing on 3 perspectives: 1) a preterminal phase of multimorbidity that is indicative of that loss of reparative or even homeokinetic properties, known by some as "advanced serious illness"; 2) the manifestations of advanced serious illness multimorbidity that, using the same networks that connect into the patient, are signs of this syndrome at the levels of the immediate family/friend social network, the broader community, and society at large; and 3) the potential for these same networks that transmit pathological forces to convey the positive effects of therapeutic interventions in a scale-free manner, with a focus on how conversation can lead to what I'm calling "multibeneficence."
authors.affiliation: Common Practice, 1227 N. 4th Street, Philadelphia, Pennsylvania, 19122, USA.
authors.forename: Jeffrey
authors.identifier: http://orcid.org/0000-0003-3060-1459
authors.initials: J
authors.lastname: Cohn
mesh_terms: D017028:Caregivers / Q000523:psychology; D005190:Family / Q000523:psychology; D005382:Financing, Personal; D006801:Humans; D007398:Interpersonal Relations; D000076322:Multimorbidity; D000071069:Multiple Chronic Conditions / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology*; D012720:Severity of Illness Index; D064890:Social Determinants of Health; D017132:Workplace / Q000523:psychology