Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

Tapper, Elliot B.; Singal, Amit G.; Navarro, Victor J.

doi:10.1002/hep.31226

Cited by 28 publications

(25 citation statements)

References 46 publications

(44 reference statements)

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“…The purpose of palliative care is to provide support to patients, families, and caregivers by focusing of symptom management, facilitating goals of care discussion and advanced care planning, and end of life care. Hospice level of care is considered and offered for patients with a life expectancy less than 6 months [ 8 ]. Therefore, palliative care should be offered as early as end-stage diseases are identified.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Palliative Care Services on Treatment and Resource Utilization for Hepatorenal Syndrome in the United States

et al. 2021

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Background: This study aimed to determine the rates of inpatient palliative care service use and assess the impact of palliative care service use on in-hospital treatments and resource utilization in hospital admissions for hepatorenal syndrome. Methods: Using the National Inpatient Sample, hospital admissions with a primary diagnosis of hepatorenal syndrome were identified from 2003 through 2014. The primary outcome of interest was the temporal trend and predictors of inpatient palliative care service use. Logistic and linear regression was performed to assess the impact of inpatient palliative care service on in-hospital treatments and resource use. Results: Of 5571 hospital admissions for hepatorenal syndrome, palliative care services were used in 748 (13.4%) admissions. There was an increasing trend in the rate of palliative care service use, from 3.3% in 2003 to 21.1% in 2014 (p < 0.001). Older age, more recent year of hospitalization, acute liver failure, alcoholic cirrhosis, and hepatocellular carcinoma were predictive of increased palliative care service use, whereas race other than Caucasian, African American, and Hispanic and chronic kidney disease were predictive of decreased palliative care service use. Although hospital admission with palliative care service use had higher mortality, palliative care service was associated with lower use of invasive mechanical ventilation, blood product transfusion, paracentesis, renal replacement, vasopressor but higher DNR status. Palliative care services reduced mean length of hospital stay and hospitalization cost. Conclusion: Although there was a substantial increase in the use of palliative care service in hospitalizations for hepatorenal syndrome, inpatient palliative care service was still underutilized. The use of palliative care service was associated with reduced resource use.

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Section: Introductionmentioning

confidence: 99%

“…Although the benefits of palliative care in end-stage liver disease have been well established, palliative care consultation remains low [ 8 , 9 , 10 , 11 ]. Data regarding the utilization of palliative care in patients diagnosed with hepatorenal syndrome is limited.…”

Section: Introductionmentioning

confidence: 99%

Impact of Palliative Care Services on Treatment and Resource Utilization for Hepatorenal Syndrome in the United States

et al. 2021

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“…Despite improvements in health care, mortality due to ESLD increased by 65% from 1999 to 2016 [ 7 ]. Patients with ESLD have limited treatment options and have a deteriorated quality of life with an uncertain prognosis [ 8 ]. Early identification of patients with ESLD who have a poor prognosis is fundamental for palliative care.…”

Section: Introductionmentioning

confidence: 99%

Machine-Learning Monitoring System for Predicting Mortality Among Patients With Noncancer End-Stage Liver Disease: Retrospective Study

Lin¹,

Chen²,

Tang³

et al. 2020

JMIR Med Inform

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Background Patients with end-stage liver disease (ESLD) have limited treatment options and have a deteriorated quality of life with an uncertain prognosis. Early identification of ESLD patients with a poor prognosis is valuable, especially for palliative care. However, it is difficult to predict ESLD patients that require either acute care or palliative care. Objective We sought to create a machine-learning monitoring system that can predict mortality or classify ESLD patients. Several machine-learning models with visualized graphs, decision trees, ensemble learning, and clustering were assessed. Methods A retrospective cohort study was conducted using electronic medical records of patients from Wan Fang Hospital and Taipei Medical University Hospital. A total of 1214 patients from Wan Fang Hospital were used to establish a dataset for training and 689 patients from Taipei Medical University Hospital were used as a validation set. Results The overall mortality rate of patients in the training set and validation set was 28.3% (257/907) and 22.6% (145/643), respectively. In traditional clinical scoring models, prothrombin time-international normalized ratio, which was significant in the Cox regression (P<.001, hazard ratio 1.288), had a prominent influence on predicting mortality, and the area under the receiver operating characteristic (ROC) curve reached approximately 0.75. In supervised machine-learning models, the concordance statistic of ROC curves reached 0.852 for the random forest model and reached 0.833 for the adaptive boosting model. Blood urea nitrogen, bilirubin, and sodium were regarded as critical factors for predicting mortality. Creatinine, hemoglobin, and albumin were also significant mortality predictors. In unsupervised learning models, hierarchical clustering analysis could accurately group acute death patients and palliative care patients into different clusters from patients in the survival group. Conclusions Medical artificial intelligence has become a cutting-edge tool in clinical medicine, as it has been found to have predictive ability in several diseases. The machine-learning monitoring system developed in this study involves multifaceted analyses, which include various aspects for evaluation and diagnosis. This strength makes the clinical results more objective and reliable. Moreover, the visualized interface in this system offers more intelligible outcomes. Therefore, this machine-learning monitoring system provides a comprehensive approach for assessing patient condition, and may help to classify acute death patients and palliative care patients. Upon further validation and improvement, the system may be used to help physicians in the management of ESLD patients.

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“…Early integration of palliative care (PC) for patients with ESLD and their family caregivers is recommended, ( 7 , 8 , 9 , 10 ) yet remains underutilized. ( 11 , 12 , 13 , 14 , 15 ) One of the reasons for this is a limited specialty PC workforce.…”

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confidence: 99%

Palliative Care Always: Hepatology—Virtual Primary Palliative Care Training for Hepatologists

et al. 2021

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Palliative care (PC) benefits patients with serious illness including end‐stage liver disease (ESLD). As part of a cluster randomized trial, hepatologists were trained to deliver primary palliative care to patients with ESLD using an online course, Palliative Care Always: Hepatology (PCA:Hep). Here we present a multimethod formative evaluation (feasibility, knowledge acquisition, self‐efficacy, and practice patterns) of PCA:Hep. Feasibility was measured by completion of coursework and achieving a course grade of >80%. Knowledge acquisition was measured through assessments before and throughout the course. Pre/post‐course surveys were conducted to determine self‐efficacy and practice patterns. The hepatologists (n = 39) enrolled in a 12‐week online course and spent 1‐3 hours on the course weekly. The course was determined to be feasible as 97% successfully completed the course and 100% passed. The course was acceptable to participants; 91.7 % reported a positive course experience and satisfaction with knowledge gained (91.6%). The pre/post knowledge assessment showed an improvement of 6.0% (pre 85.9% to post 91.9%, 95% CI [2.8, 9.2], P = 0.001). Self‐efficacy increased significantly (P < 0.001) in psychological symptom management, hospice, and psychosocial support. A year after training, over 80% of the hepatologists reported integrating a variety of PC skills into routine patient care. Conclusion: PCA:Hep is feasible, acceptable, and improves learner knowledge and confidence in palliative care skills. This is a viable method to teach primary PC skills to specialists caring for patients with ESLD.

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Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

Cited by 28 publications

References 46 publications

Impact of Palliative Care Services on Treatment and Resource Utilization for Hepatorenal Syndrome in the United States

Impact of Palliative Care Services on Treatment and Resource Utilization for Hepatorenal Syndrome in the United States

Machine-Learning Monitoring System for Predicting Mortality Among Patients With Noncancer End-Stage Liver Disease: Retrospective Study

Palliative Care Always: Hepatology—Virtual Primary Palliative Care Training for Hepatologists

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