Double Burden, Double Delay: Multimorbidity and Missed Opportunities for Timely Palliative Care

Key Message : Multimorbidity was associated with delayed palliative care consultation and less favorable outcomes, including higher ICU admission, longer hospital stays, and lower hospice referral rates compared to single-disease groups. These findings highlight the need for tailored strategies to improve timely consultation and care quality for complex patients.

Abstract: Background/Rationale: Early inpatient palliative care enhances symptom management, care transitions, and goal-concordant treatment.1 Patients with multiple serious illnesses often experience delayed care, underscoring the need to understand how multimorbidity impacts palliative care access and outcomes.

Objectives/

Purpose: To evaluate how multimorbidity (≥2 serious illnesses) impacts the timing of inpatient PC consultation and associated outcomes.

Methods/Approach: We conducted a retrospective cohort study of hospitalized adults with at least one of the serious illnesses - HF, Cancer, Dementia or ESRD who received PC consultation during admission across a large Southeastern U.S. health system from April 2024 to March 2025. Multimorbidity was defined as having ≥2 of these serious illnesses. Multivariable logistic regression models were employed for binary outcomes, and time-dependent Cox regression was applied for LOS.

Results: Among the 13,450 eligible patients, 27% had more than one serious illness. Among them 17.7% received PC within 24h, lower than cancer patients (25%) but higher than ESRD patients (10%) (p < 0.001). Nearly half (47%) were seen after 72h. Consultation rates within 72 hours showed a similar pattern. After adjustment, multimorbidity patients remained less likely to receive consultation within 72 hours than cancer patients but more likely than ESRD patients. Patients with multimorbidity had higher ICU use, longer stays, and fewer hospice referrals than cancer-only patients, but similar in-hospital mortality. Compared to dementia-only patients, they had higher mortality and ICU use. Compared to heart failure-only patients, they stayed longer, had higher mortality but used ICU less. Outcomes were similar to those with ESRD only.

Conclusion/Implications: Multimorbidity was associated with delayed inpatient palliative care consultation and less favorable care outcomes compared to patients with single serious illnesses, especially those with cancer or dementia. The findings highlight the need to embed multimorbidity into referral strategies to ensure timely access to palliative care and improve outcomes for patients with multimorbidity.

References: 1. Srinivasan VJ, Akhtar S, Huppertz JW, Sidhu M, Coates A, Knudsen N. Prospective cohort study on the impact of early versus late inpatient palliative care on length of stay and cost of care. Am J Hosp Palliat Care. Jul 2023;40(7):704-710. doi:10.1177/10499091231152609