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Palliative care in cirrhosis with decompensation
Angela Plunkett1,2, Marianne Mortimore2,3, Phillip Good2,4
1Department of Palliative and Supportive Care, Royal Brisbane and Women's Hospitals, Brisbane, Queensland, Australia.
Internal Medicine Journal
|July 12, 2019
Summary
Patients with decompensated cirrhosis experience severe symptoms and high mortality but are rarely referred to palliative care. This pilot study highlights a critical gap in supportive care for these patients, impacting quality of life and increasing healthcare utilization.
Area of Science:
- Hepatology
- Palliative Care
- Geriatric Medicine
Background:
- Decompensated cirrhosis presents a poor prognosis and significant symptom burden.
- Caregiver stress is a notable consequence of managing patients with advanced liver disease.
- Existing healthcare models may not adequately address the complex needs of this patient population.
Purpose of the Study:
- To investigate the referral patterns of patients with decompensated cirrhosis to specialist palliative care.
- To assess the symptom burden, mortality risk, and healthcare utilization in this patient group.
- To evaluate the extent of advance care planning among patients with decompensated cirrhosis.
Main Methods:
- Pilot research conducted in a single tertiary hospital setting.
- Retrospective analysis of patient records.
- Assessment of symptom burden, mortality prediction, hospital admission data, and advance care planning documentation.
Main Results:
- Patients with decompensated cirrhosis were infrequently referred to specialist palliative care.
- These patients exhibited a heavy symptom burden and high predicted mortality.
- Frequent unplanned readmissions, prolonged hospital stays, and intensive care unit admissions were observed, with limited advance care planning.
Conclusions:
- There is a significant underutilization of specialist palliative care for patients with decompensated cirrhosis.
- These patients face substantial symptom burden and high mortality, necessitating integrated supportive care.
- Improved advance care planning and palliative care integration are crucial for enhancing patient outcomes and quality of life.
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