Multimorbidity through the lens of life-limiting illness: how helpful are Australian clinical practice guidelines to its management in primary care?
Raechel A. Damarell
A C , Deidre D. Morgan A B , Jennifer J. Tieman A and David F. Healey B
+ Author Affiliations
- Author Affiliations
A Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Rehabilitation and Palliative Care Building, 4W330, Flinders Medical Centre, Bedford Park, SA 5042, Australia.
B Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
C Corresponding author. Email: Raechel.damarell@flinders.edu.au
Australian Journal of Primary Health 27(2) 122-129 https://doi.org/10.1071/PY20164
Submitted: 30 June 2020 Accepted: 28 October 2020 Published: 19 January 2021
Abstract
This study assessed Australian clinical practice guidelines for life-limiting index conditions for the extent to which they acknowledged comorbidities and framed management recommendations within the context of older age and reduced life expectancy. A comprehensive search identified current, evidence-based Australian guidelines for chronic life-limiting conditions directed at general practitioners. Guideline content was analysed qualitatively before comorbidity acknowledgements were quantified using a 17-item checklist. Full guidelines were quality appraised using AGREE-II. Ten documents covering chronic obstructive pulmonary disease, heart failure, cancer pain, dementia and palliative care in aged care were identified. Most guidelines addressed one ‘comorbid’ condition and prompted clinicians to consider patient quality of life and personal preferences. Fewer addressed burden of treatment and half suggested modifying treatments to account for limited life expectancy, age or time horizon to benefit. Half warned of potential adverse drug interactions. Guidelines were of moderate to very high quality. Guidelines naturally prioritised their index condition, directing attention to only the most common comorbidities. However, there may be scope to include more condition-agnostic guidance on multimorbidity management. This might be modelled on the ‘guiding principles’ approach now emerging internationally from organisations such as the American Geriatrics Society in response to increasing multimorbidity prevalence and evidence limitations.
Keywords: general practitioners, multimorbidity, life expectancy, practice guidelines, evidence-based medicine, Australia.
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