How to move to a palliative approach to care for people with multimorbidity

In the first editorial in this series, Mangin and Jamoulee commented on a recent Institute of Medicine report, Living Well with Chronic Illness, which called for a paradigm shift from disease based models of care to one focused on care for patients.1 Recently, Haggerty, when discussing continuity of care for patients with multimorbidity, highlighted that patients can experience chaotic care.2 As patients with multimorbidity age and healthcare providers face increased problems with delivering complex care, doctors must identify when it is appropriate to broach the subject of scaling back or stopping treatment; they must then decide in what particular order to taper or eliminate treatments. How can clinicians and patients move through the change from disease modifying treatment to a palliative approach to care with the strong continuity Haggerty suggests?

Consider an elderly woman with five illnesses who lives alone. She has heart disease, severe osteoarthritis and rheumatoid arthritis, hypertension, and a foot ulcer; she is also poor and socially isolated, with no children living nearby. The key question for the coordinating clinician to ask is: “Would I be surprised …