Intended for healthcare professionals

Practice Practice Pointer

Using illness trajectories to inform person centred, advance care planning

BMJ 2024; 384 doi: (Published 01 March 2024) Cite this as: BMJ 2024;384:e067896

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  1. Scott A Murray, emeritus professor of primary palliative care1,
  2. Kirsty Boyd, reader in palliative care1,
  3. Sebastien Moine, general practitioner1 2,
  4. Marilyn Kendall, social scientist1,
  5. Stella Macpherson, patient/carer representative1 3,
  6. Geoffrey Mitchell, emeritus professor of general practice and palliative care4,
  7. Jordi Amblàs-Novellas, chair of palliative care5
  1. 1Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
  2. 2Health Education and Practices Laboratory, University of Paris 13, Bobigny, France
  3. 3patient author, UK
  4. 4University of Queensland, Australia
  5. 5Central Catalonia Chronicity Research Group, Faculty of Medicine, University of Vic-Central University of Catalonia, 08500 Vic, Spain
  1. Correspondence to: S A Murray Scott.Murray{at}

What you need to know

  • 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

Patients diagnosed with a serious illness often ask doctors about prognosis as a way into talking about what life might be like in the future.12 Illness trajectories can offer conceptual maps of archetypical patient journeys in the final years and months of life. Trajectories have been used clinically for nearly 20 years to aid timely identification and assessment of people for a palliative care approach34 and, more recently, in population based studies of access to palliative care.56 Advance care planning involves making plans with the patient and family when there is a risk of deterioration so that future care is in line with what matters to them and informed by clinical advice. Person centred conversations are central to meaningful advance care planning, and discussing a possible future illness trajectory can be a useful part of the process.78 This article offers an overview of illness trajectories that may be relevant for people with any progressive illnesses and suggests how they can be used as part of conversations about advance care planning.

Video 1

What are illness trajectories, and how can they inform advance care planning?

What are the main illness trajectories?

Three main illness trajectories of physical decline from progressive illness are described from empirical …

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