Journal article
Palliative Care and End-of-Life Outcomes in Patients Considered for Liver Transplantation: A Single-Center Experience in the US Midwest
American journal of hospice & palliative medicine, Vol.40(10), pp.104990912211428-10499091221142841
10/2023
DOI: 10.1177/10499091221142841
PMID: 36448659
Abstract
Introduction: Previous research has shown limited palliative care (PC) utilization among patients evaluated for liver transplantation (LT) despite the cohort’s significant symptom burden, high frequency of hospitalization and risk of rapid decompensation. Our aim was to evaluate patient characteristics and end-of-life (EOL) outcomes (i.e. ICU utilization, code status, advance care planning) associated with the use of PC services in patients who were evaluated for LT. Methods: We performed a single-center cross-sectional study comprised of 223 deceased patients evaluated for LT between 1/1/2017 and 12/31/2021. We evaluated demographic characteristics and EOL outcomes for differences between patients who received PC consultation and those who did not. EOL outcomes associated with PC use were assessed using logistic and linear regression analysis adjusted for patient demographics. Results: Patients who received PC consultation were younger (mean 57 vs. 61; P = 0.048), had higher Model for end-stage Liver Disease (MELD) scores (27.5 vs. 22; P = 0.001), higher rates of hepatic encephalopathy (96% vs. 84%, P = 0.005), and were more frequently declined for LT (77% vs. 57%; P = 0.008). Patients who received PC services were less likely to die in the ICU (OR = 0.07 [0.02-0.18]) and were more likely to have documented advance care planning (OR = 3.16 [1.47-6.97]), family meetings (OR = 6.58 [2.72-17.08]), and goals-of-care discussions (OR = 14.83 [4.39-69.29]). Conclusion: For patients being evaluated for LT, PC utilization differed based on demographics, disease complications and severity, and transplant status. Those who received PC services had higher quality EOL care planning and fewer ICU admissions.
Details
- Title: Subtitle
- Palliative Care and End-of-Life Outcomes in Patients Considered for Liver Transplantation: A Single-Center Experience in the US Midwest
- Creators
- Sawyer F Kieffer - Thomas Jefferson University HospitalTomohiro Tanaka - University of IowaAmy C Ogilvie - University of IowaStephanie Gilbertson-White - University of IowaYuya Hagiwara - University of Iowa
- Resource Type
- Journal article
- Publication Details
- American journal of hospice & palliative medicine, Vol.40(10), pp.104990912211428-10499091221142841
- DOI
- 10.1177/10499091221142841
- PMID
- 36448659
- ISSN
- 1049-9091
- eISSN
- 1938-2715
- Language
- English
- Electronic publication date
- 11/30/2022
- Date published
- 10/2023
- Academic Unit
- Epidemiology; Gastroenterology and Hepatology; Nursing; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359699202771
Metrics
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