Using Illness Trajectories - including that of multi-morbidity - to inform person-centred, advance care planning

This short video offers an overview of illness trajectories relevant to people with any progressive illness(s), and suggests how they can be incorporated into a four-stage care cycle for advance care planning. Particular attention is given to consider how patients with two or more significant illnesses can receive person-centred and coordinated care.

• Most patients with progressive illness follow characteristic trajectories of decline, previously identified as rapid, intermittent, or a gradual decline from a low baseline
• Multimorbidity is increasingly common and follows a distinct fourth trajectory
• An understanding of the dynamic multidimensional trajectories of patients with progressive illnesses helps clinicians consider individual holistic needs and have meaningful conversations with patients and families about advance care planning
• In patients with an acute deterioration in health (such as from an infection), considering the main underlying illness trajectory helps guide shared decision making about realistic current and future treatment and care options

The video was embedded into the online abstract of a paper submitted to the BMJ.

Murray SA, Boyd K, Moine S, Kendall M, Macpherson S, Mitchell G, Amblàs-Novellas J. Using illness trajectories to inform person centred, advance care planning. BMJ 2024; 384 :e067896 doi:10.1136/bmj-2021-067896