Palliative Care and Hospice Referrals in Patients with Decompensated Cirrhosis: What Factors Are Important?

Holden, John; Shamseddeen, Hani; Johnson, Amy W.; Byriel, Benjamin; Subramoney, Kavitha; Cheng, Yao-Wen; Saito, Akira; Ghabril, Marwan; Chalasani, Naga; Sachs, Greg A.; Orman, Eric S.

doi:10.1089/jpm.2019.0501

Cited by 26 publications

(35 citation statements)

References 32 publications

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“…Our study identified several variables associated with increased or decreased palliative care service use in hospitalized patients with hepatorenal syndrome. Similar to our study, a previous single-center study from the United States also identified that older age and hepatocellular carcinoma predicted increased rates of palliative care consultation in end-stage liver disease [ 11 ]. These patients often do not meet criteria for consideration of liver transplantation and, thus, palliative care is appropriate [ 15 ].…”

Section: Discussionsupporting

confidence: 89%

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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: Discussionsupporting

confidence: 89%

“…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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“…( 90 , 106 ) However, in studies where timing of PC and hospice use could be measured, referrals were often made close to the time of death. ( 29 , 83 , 84 , 90 , 107 , 108 ) Specific patient, family, and provider barriers to hospice use have not been published.…”

Section: Resultsmentioning

confidence: 99%

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

et al. 2021

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Individuals with advanced liver disease (AdvLD), such as decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC), have significant palliative needs. However, little research is available to guide health care providers on how to improve key domains related to palliative care (PC). We sought to identify priority areas for future research in PC by performing a comprehensive literature review and conducting iterative expert panel discussions. We conducted a literature review using search terms related to AdvLD and key PC domains. Individual reviews of these domains were performed, followed by iterative discussions by a panel consisting of experts from multiple disciplines, including hepatology, specialty PC, and nursing. Based on these discussions, priority areas for research were identified. We identified critical gaps in the available research related to PC and AdvLD. We developed and shared five key priority questions incorporating domains related to PC. Conclusion: Future research endeavors focused on improving PC in AdvLD should consider addressing the five key priorities areas identified from literature reviews and expert panel discussions. (Hepatology Communications 2021;0:1-12).

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“…One recent study by Holden et al showed that notwithstanding the morbidity and mortality associated with decompensated liver disease, only 33% of those who died were referred to hospice, and often this referral came only days before death. ( 32 ) Other studies have demonstrated similarly low rates of palliative care consultation in the ESLD population, with particularly low rates to address pain management. ( 33‐36 ) This low referral rate exists despite the use of aggressive treatments and interventions along with high health care costs and symptom burden in patients with ESLD.…”

Section: Discussionmentioning

confidence: 96%

National Trends in Location of Death in Patients With End‐Stage Liver Disease

et al. 2021

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Despite improvement in the care of patients with end‐stage liver disease (ESLD), mortality is rising. In the United States, patients are increasingly choosing to die at hospice and home, but data in patients with ESLD are lacking. Therefore, this study aimed to describe the trends in location of death in patients with ESLD. We conducted a retrospective cross‐sectional analysis using the Centers for Disease Control and Prevention Wide‐Ranging OnLine Data for Epidemiologic Research from 2003 to 2018. Death location was categorized as hospice, home, inpatient facility, nursing home, or other. Comparisons were made between sex, age, ethnicity, race, region, and other causes of death. Comparisons were also made between rates of change (calculated as annual percent change), proportion of deaths in 2018, and multivariable logistic regression. A total of 535,261 deaths were attributed to ESLD—most were male, non‐Hispanic, and White. The proportion of deaths at hospice and home increased during the study period from 0.2% to 10.6% and 20.3% to 25.7%, respectively. Whites had the highest proportion of deaths in hospice and home. In multivariable analysis, elderly patients were more likely to die in hospice or home (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.07‐1.35), whereas Black patients were less likely (OR, 0.58; 95% CI, 0.46‐0.73). Compared with other causes of death, ESLD had the second highest proportion of deaths in hospice but lagged behind non–hepatocellular carcinoma malignancy. Deaths in patients with ESLD are increasingly common at hospice and home overall, and although the rates have been increasing among Black patients, they are still less likely to die at hospice or home. Efforts to improve this disparity, promote end‐of‐life care planning, and enhance access to death at hospice and home are needed.

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Palliative Care and Hospice Referrals in Patients with Decompensated Cirrhosis: What Factors Are Important?

Cited by 26 publications

References 32 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

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

National Trends in Location of Death in Patients With End‐Stage Liver Disease

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