Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey

Abstract

Despite the likely benefits of palliative care (PC) for patients with cirrhosis, physician experiences and perspectives about best practices are variable.We aimed to assess PC experience and gaps in training among transplant hepatology fellows. We conducted a national survey of all transplant hepatology fellows enrolled in accredited fellowship programs during the 2020-2021 academic year. We assessed the frequency of PC provision and comfort with physical and psychological symptom management, psychosocial care, communication skills, advance care planning, and end-of-life care. A total of 45 of 56 (79%) of transplant hepatology fellows responded to the survey; 50% (n = 22) were female. Most trained at centers performing over 100 transplants per year (67%, n = 29) distributed evenly across geographic regions. Most fellows (69%, n = 31) had a PC or hospice care rotation during residency, and 42% (n = 19) of fellows received education in PC during transplant hepatology fellowship. Fellows reported feeling moderately to very comfortable with communication skills such as breaking bad news (93%, n = 41) and leading family meetings (75%, n = 33), but nearly one-third (30%, n = 13) reported feeling not very or not at all comfortable assessing and managing anxiety and depression (30%, n = 13) and spiritual distress (34%, n = 15). Nearly

Predictors and Outcomes of Palliative Care Consultations for Patients With Liver Disease: Results of a Cohort Study of 75 Million Medical Records

“…It also noted deficiencies in comfort levels managing mental health, pain and spiritual distress. 21 Hence, there is a need for addressing palliative care training for specialists.…”

Improving palliative and supportive care in advanced cirrhosis: the HepatoCare model of integrated collaborative care

“…This facilitates valuable contributions from each specialty. In a recent survey of all US liver transplant fellows (79% response rate), 68% felt they needed further training on the management of physical symptoms in patients with advanced disease and 33% were uncomfortable managing anxiety and depression 37 . The HepatoCare model of shared care provides expertise in these areas and also offers the benefits of streamlined end‐of‐life decision‐making when the patient's clinical condition or goals of care necessarily change.…”

Prediction of long-term survival among patients with cirrhosis using time-varying models

“…This information could help to inform advanced care planning, often not discussed in patients with cirrhosis, referral for transplant evaluation, and weighing decisions for nonliver-related care that may be impacted by a patient’s cirrhosis-related prognosis (eg, the aggressiveness of lung cancer therapy in a patient with early-stage lung cancer). 40 – 44 The goal of these time-updating models is to allow clinicians to predict the risk of mortality among patients with cirrhosis, accounting not only for their current clinical status but also for changes over time. Current cirrhosis risk scores, such as the MELD score, VHA score, and the long-term cirrhosis survival score, developed by our group 5 all are based on baseline (VHA and long-term cirrhosis survival) or current lab (MELD) values, without the consideration of changes over time.…”