Journal article
Palliative Care and End-of-Life Outcomes in Patients Considered for Liver Transplantation: Single-Center Experience in the US Midwest (Sci243)
Journal of pain and symptom management, Vol.65(5), e663
05/2023
DOI: 10.1016/j.jpainsymman.2023.02.293
Abstract
1. Describe characteristics, symptom burden, and outcomes of patients evaluated for liver transplant requiring palliative care consultation.
2. Describe the indications for liver transplant and outcomes of patients being referred for liver transplant evaluation.
Previous research has shown limited palliative care (PC) utilization among end-stage liver disease (ESLD) patients being evaluated for liver transplantation (LT). Our aim was to evaluate patient characteristics and EOL outcomes associated with the use of PC services in deceased patients who were evaluated for LT.
We performed a cross-sectional study comprising deceased patients evaluated for LT between January 1, 2017 and December 31, 2021 at a tertiary academic LT center in the Midwest. We compared characteristics of patients who received PC consultation (n = 100) and those who did not (n = 120). Additionally, we evaluated a subset of patients who had comprehensive EOL data available (n = 129). Outcomes were assessed using logistic and linear regression analysis adjusted for patient demographics.
Patients who received PC consultation were younger (mean 56 vs. 61; p = 0.035), had higher MELD scores (27 vs. 22; p = 0.002), did not have hepatocellular carcinoma (11% vs. 23%, p=0.03), had hepatic encephalopathy (96% vs. 83%, p=0.005), and were declined for LT (76% vs. 57%; p = 0.012). There was no association between PC consultation and socioeconomic factors. Patients who received PC services had fewer intensive care unit (ICU) use during their last hospitalization (OR=0.3 [95% CI: 0.01-0.78) and were less likely to die in the ICU (OR=0.07 [0.02-0.19]). Additionally, patients who received PC services were more likely to have documented advance care planning (OR=3.3 [1.5-703]), family meetings (OR=7.2 [2.9-19.3]), and goals-of-care discussions (OR= 20.9 [5.4-139.8]).
PC is underutilized in those considered for LT. PC use is associated with higher quality EOL care with fewer ICU admissions and greater rates of advance care planning, family meetings, and goals-of-care discussions. Further study of palliative care involvement in patients being considered for LT is warranted.
Details
- Title: Subtitle
- Palliative Care and End-of-Life Outcomes in Patients Considered for Liver Transplantation: Single-Center Experience in the US Midwest (Sci243)
- Creators
- Sawyer Kieffer - Thomas Jefferson University HospitalTomohiro Tanaka - University of IowaAmy Ogilvie - University of IowaStephanie Gilbertson-White - University of IowaYuya Hagiwara - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of pain and symptom management, Vol.65(5), e663
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jpainsymman.2023.02.293
- ISSN
- 0885-3924
- eISSN
- 1873-6513
- Language
- English
- Date published
- 05/2023
- Academic Unit
- Gastroenterology and Hepatology; Nursing; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984388759602771
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