Intended for healthcare professionals


Illness trajectories in the age of big data

BMJ 2024; 384 doi: (Published 01 March 2024) Cite this as: BMJ 2024;384:q510

Linked Practice

Illness trajectories of incurable solid cancers

Linked Practice

Using illness trajectories to inform person centred, advance care planning

  1. Peter Tanuseputro, associate professor1,
  2. Colleen Webber, postdoctoral fellow12,
  3. James Downar, professor123
  1. 1Investigator, Bruyere Research Institute, Ottawa ON, Canada
  2. 2Ottawa Hospital Research Institute, Ottawa ON, Canada
  3. 3Department of Medicine, University of Ottawa, Ottawa ON, Canada
  1. Correspondence to: P Tanuseputro peter.tanuseputro{at}

Advanced analytics may help move from population to personalised predictions

For decades, healthcare providers have understood that patients follow typical trajectories of health decline as they approach the end of life, and they have used this understanding to help patients and families anticipate the dying process. Traditional trajectories focus on function or overall health status and include sudden death, terminal illness (rapid and accelerating deterioration), organ failure (slower decline marked by periods of acute exacerbation and recovery), and frailty (slow decline with fewer acute changes).1

Two Education articles in the BMJ add novel dimensions to our understanding of health decline. Murray et al explain how declines in function do not always mirror declines in social, psychological, and spiritual dimensions. They also add a new trajectory, multimorbidity, to describe a person with conditions from multiple trajectories (such as heart disease from organ failure and cognitive impairment from frailty).2 Geijteman et al describe how …

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