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

Despite significant morbidity and mortality, patients with cirrhosis are infrequently referred to palliative care (PC). We developed a hepatology-PC collaborative care program to improve access to PC and quality of care for patients with cirrhosis.

This mixed methods cohort study included adult patients with cirrhosis who were referred to outpatient PC between 2021 and 2023. Rates of advance care planning (ACP) and health care utilization six months before and after PC program initiation were compared. Clinicians participated in a focus group and completed a survey to provide feedback on the program.

A total of 41 patients (44% female, median age 61) were seen by both hepatology and PC teams. A PC physician, nurse, social worker, and/or spiritual care provider addressed non-pain symptoms (81%), ACP (68%), mood (63%), pain (59%), family/caregiver support (34%), social needs (24%), and spiritual concerns (15%). With PC, patients had increased ACP note completion (34% vs. 95%, p < 0.001), surrogate decision maker identification (46% vs. 83%, p < 0.001), and code status documentation (64% vs. 78%, p = 0.03). There were no differences in rates of non-elective hospitalizations or emergency department visits from six months before to six months after PC initiation. In a survey of clinicians who participated in the program (n = 11), all clinicians recommended continuing the co-management program and for other health systems to develop similar collaborations.

Hepatology-PC co-management is feasible and positively received by hepatology and PC clinicians alike. Outpatient PC addresses needs in multiple domains for patients and caregivers and is associated with increased rates of ACP.