Palliative Care Co-management at a Liver Transplant Center: A Mixed Methods Study

Area of Science:

• Hepatology
• Palliative Care
• Health Services Research

Background:

• Cirrhosis patients experience significant morbidity and mortality.
• Referral rates to palliative care (PC) for cirrhosis patients are low.
• A collaborative hepatology-PC program was developed to enhance PC access and care quality.

Purpose of the Study:

• To evaluate the feasibility and impact of a hepatology-PC collaborative care program.
• To assess changes in advance care planning (ACP) and healthcare utilization.
• To gather clinician feedback on the co-management model.

Main Methods:

• Mixed methods cohort study of adult cirrhosis patients referred to outpatient PC (2021-2023).
• Comparison of ACP and healthcare utilization rates six months before and after PC program initiation.
• Clinician focus groups and surveys for program feedback.

Main Results:

• 41 patients received integrated hepatology and PC care.
• PC addressed non-pain symptoms (81%), ACP (68%), mood (63%), and pain (59%).
• Significant increases observed in ACP completion (34% to 95%), surrogate decision-maker identification (46% to 83%), and code status documentation (64% to 78%).
• No significant changes in non-elective hospitalizations or emergency department visits.
• 100% of surveyed clinicians recommended continuing the program.

Conclusions:

• Hepatology-PC co-management is a feasible model for cirrhosis care.
• The program is positively received by both hepatology and PC clinicians.
• Outpatient PC effectively addresses diverse patient and caregiver needs, increasing ACP rates.