- 1.Describe Palliative Care (PC) referral reasons, timing, and outcomes for patients with end stage liver disease (ESLD) at a large academic transplant center with limited outpatient PC access for ESLD patients.
- 2.Identify targets for future clinical care initiatives and research with aim to improve upstream access to PC for ESLD patients and their families.
Patients with end-stage liver disease (ESLD) have significant symptom burden and psychosocial needs, along with unpredictable clinical trajectories. These patients may benefit from Palliative Care (PC) alongside disease-directed therapies. However, PC is often underutilized or delayed until the end of life (EOL). Investigation of our referral patterns and outcomes may identify ways to increase upstream access to PC.
To characterize PC referral reasons, timing, and outcomes for patients with ESLD admitted to our institution
We performed a retrospective chart review of hospitalized patients with ESLD who received inpatient PC consultation between February 2017 and February 2019. Death data was obtained via medical record and obituaries. Descriptive statistics were used for referral reasons and outcomes, and Kaplan-Meier curves were constructed to analyze the chronologic relationship between PC consult, hospice referral, and death.
Out of 230 encounters, most PC referrals were for goals of care (89%). Nearly one quarter (24%) of patients sought disease-directed care at discharge, over one third (40%) discharged with hospice services, and another third (35%) died in the hospital. Median time from study period PC consult to hospice referral was thirteen days (95% CI: 8, 24) and from study period PC consult to death was fourteen days (95% CI: 10, 18). Eighty five percent of patients were confirmed deceased by study closure.
Most PC referrals for ESLD patients occurred near EOL, and many patients shifted to comfort-focused care after PC involvement. Late referrals may be due to lack of outpatient PC for ESLD patients at our institution, leading to reliance on inpatient consults during acute illness.
Implications for Research, Policy, or Practice
Improved upstream PC access may lead to earlier identification of patient care goals and improve goal concordant care. Future work at our institution should focus on expanding early access to PC for patients with ESLD.
© 2021 Published by Elsevier Inc.