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dc.contributor.authorMorgan, Deidre Den_US
dc.contributor.authorTieman, Jenniferen_US
dc.contributor.authorAllingham, Samuel Fen_US
dc.contributor.authorEkstrom, Magnusen_US
dc.contributor.authorConnolly, Alannaen_US
dc.contributor.authorCurrow, David Christopheren_US
dc.date.accessioned2019-03-28T22:38:58Z
dc.date.available2019-03-28T22:38:58Z
dc.date.issued2019-03-27
dc.identifier.citationMorgan, D. D., Tieman, J. J., Allingham, S. F., Ekström, M. P., Connolly, A., & Currow, D. C. (2019). The trajectory of functional decline over the last 4 months of life in a palliative care population: A prospective, consecutive cohort study. Palliative Medicine, 26921631983902. https:// doi.org/10.1177/0269216319839024en_US
dc.identifier.issn0269-2163
dc.identifier.urihttp://hdl.handle.net/2328/39108
dc.descriptionThis article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for selfarchiving. © The Author(s) 2019en_US
dc.description.abstractBackground: Understanding current patterns of functional decline will inform patient care and has health service and resource implications. Aim: This prospective consecutive cohort study aims to map the shape of functional decline trajectories at the end of life by diagnosis. Design: Changes in functional status were measured using the Australia-modified Karnofsky Performance Status Scale. Segmented regression was used to identify time points prior to death associated with significant changes in the slope of functional decline for each diagnostic cohort. Sensitivity analyses explored the impact of severe symptoms and late referrals, age and sex. Setting/participants: In all, 115 specialist palliative care services submit prospectively collected patient data to the national Palliative Care Outcomes Collaboration across Australia. Data on 55,954 patients who died in the care of these services between 1 January 2013 and 31 December 2015 were included. Results: Two simplified functional decline trajectories were identified in the last 4 months of life. Trajectory 1 has an almost uniform slow decline until the last 14 days of life when function declines more rapidly. Trajectory 2 has a flatter more stable trajectory with greater functional impairment at 120 days before death, followed by a more rapid decline in the last 2 weeks of life. The most rapid rate of decline occurs in the last 2 weeks of life for all cohorts. Conclusions: Two simplified trajectories of functional decline in the last 4 months of life were identified for five patient cohorts. Both trajectories present opportunities to plan for responsive healthcare that will support patients and families.en_US
dc.language.isoenen_US
dc.publisherSageen_US
dc.rights© The Author(s) 2019en_US
dc.subjectPalliative careen_US
dc.subjectend-of-life careen_US
dc.subjectfunctionally impaired elderlyen_US
dc.subjectfunctional declineen_US
dc.subjecttrajectoriesen_US
dc.titleThe trajectory of functional decline over the last 4 months of life in a palliative care population: A prospective, consecutive cohort studyen_US
dc.typeArticleen_US
dc.identifier.doihttps://doi.org/10.1177/0269216319839024
dc.rights.holderThe Author(s)en_US
dc.rights.licenseIn Copyright
local.contributor.authorOrcidLookupMorgan, Deidre D: https://orcid.org/0000-0001-8725-9477en_US
local.contributor.authorOrcidLookupTieman, Jennifer: http://orcid.org/0000-0002-2611-1900en_US
local.contributor.authorOrcidLookupAllingham, Samuel F: https://orcid.org/0000-0002-2684-8400en_US
local.contributor.authorOrcidLookupCurrow, David Christopher: https://orcid.org/0000-0003-1988-1250en_US


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