BMJ  2005;330:1007-1011 (30 April), doi:10.1136/bmj.330.7498.1007

Clinical review

Illness trajectories and palliative care

¹ Division of Community Health Sciences, General Practice Section, University of Edinburgh, Edinburgh EH8 9DX

The first 150 words of the full text of this article appear below.

Introduction

When people with life threatening illnesses and their carers ask about prognosis ("How long have I got?"), they are often doing more than simply inquiring about life expectancy. Within this question is another, often unspoken, question about likely patterns of decline ("What will happen?"). One aid to answering both questions may be through the use of typical illness trajectories. Thinking in terms of these trajectories provides a broad timeframe and patterns of probable needs and interactions with health and social services that can, conceptually at least, be mapped out towards death.

Such frameworks may help clinicians plan and deliver appropriate care that integrates active and palliative management. If patients and their carers gain a better understanding by considering illness trajectories this may help them feel in greater control of their situation and empower them to cope with its demands. An important implication for service planners is that different models of . . . [Full text of this article]

Methods

Different trajectories for different diseases
Trajectory 1: short period of evident decline, typically cancer
Trajectory 2: long term limitations with intermittent serious episodes
Trajectory 3: prolonged dwindling

Clinical implications

-->-->Trajectories allow practical planning for a "good death"
Understanding the likely trajectory may be empowering for patient and carer

Limitations of the trajectory approach

Other dimensions of needs may have different trajectories

Implications for service planning and development

One size may not fit all
Planning care in advance may prevent admissions
Transferable lessons

Conclusions

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