Palliative care in cirrhosis with decompensation

Plunkett, Angela; Mortimore, Marianne; Good, Phillip

doi:10.1111/imj.14348

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…Despite a high symptom burden 9,23 and impact on QOL that resembles other serious medical conditions, 24 referral to PC services in cirrhosis is traditionally neglected or late. Consistent with other studies, 8,9,13,25 a minority of our patients undergoing SOC management were referred and most did not receive meaningful PC input before they died. The primary objective of our studythat HepatoCare was associated with an improved uptake of ACPwas met and the model of care meant that all patients received early outpatient PC referral.…”

Section: Discussionsupporting

confidence: 84%

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

Kearney,

Tiwari,

Cullen

et al. 2023

Internal Medicine Journal

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BackgroundPatients with advanced cirrhosis experience an unpredictable disease trajectory but are infrequently referred to palliative care (PC) services and rarely undertake advance care planning (ACP).AimWe assessed whether a novel model of care increased provision of meaningful PC in advanced cirrhosis compared with standard of care (SOC).MethodsThirty consecutive hepatology clinic outpatients with advanced cirrhosis, meeting one or more cirrhosis‐related PC referral criteria, consented to treatment in the HepatoCare clinic (PC physician, specialist liver nurse, pharmacist) in parallel with usual specialist hepatology care. A control cohort of 30 consecutive outpatients with advanced cirrhosis undergoing SOC treatment was retrospectively identified for comparison. The primary outcome was provision of meaningful PC using HepatoCare versus SOC. Additional clinical outcomes were assessed over 12 months or until death and significant differences were identified.ResultsThe intervention and control cohorts had similarly advanced cirrhosis (mean Child‐Pugh scores 8.7 vs 8.2, P = 0.46; mean model for end‐stage liver disease scores 14.4 vs 14.6, P = 0.88) but a lower 12‐month mortality rate (33% HepatoCare vs 67% SOC; P = 0.02). The intervention cohort experienced higher uptake of formal ACP (100% vs 25% for the control cohort) and outpatient PC referral (100% vs 40%), and were more likely to die at home or in a PC bed/hospice (80% vs 30%). The majority of the HepatoCare cohort (81%) had medications safely deprescribed and experienced fewer unplanned admission days (470 vs 794).ConclusionsHepatoCare is a novel multidisciplinary model of care that integrates effective PC and specialist hepatology management to improve outcomes in advanced cirrhosis.

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Section: Discussionsupporting

confidence: 84%

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

Kearney,

Tiwari,

Cullen

et al. 2023

Internal Medicine Journal

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“…Specifically, we recommend early and regular involvement of palliative care in the management of patients with HCC. At present, persons dying from cirrhosis are not frequently referred to palliative care, though the rate of referral is higher among persons with HCC along with cirrhosis 10,11 . Persons dying from both cancer and end‐organ failure, including cirrhosis, are more likely to die at home if palliative care is involved 12 .…”

Section: Discussionmentioning

confidence: 99%

Deaths from hepatocellular carcinoma are more likely to occur in medical facilities than deaths from other cancers: 2003‐2018

Truitt¹,

Khan

Gregory

et al. 2021

Liver International

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Place of death is a key indicator of quality of end‐of‐life care, and most people with a terminal diagnosis prefer to die at home. Home has surpassed the hospital as the most common location of all‐cause and total cancer‐related deaths in the United States. However, trends in place of death due to hepatocellular carcinoma (HCC), which is uniquely comanaged by hepatologists and oncologists, have not been described. We analysed US death certificate data from 2003 to 2018 for the proportion of deaths over time at medical facilities, nursing facilities, hospice facilities and home, for HCC and non‐HCC cancer. The proportion of deaths increased from 0.6% to 15.2% in hospice facilities (P trend < 0.0001) but did not change at home. In multivariable analysis, persons with HCC were more likely than persons with non‐HCC cancer to die in medical facilities, while persons with HCC were less likely to die at home.

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“…Recent systematic reviews suggest that clinician education, clinical decision support at point of care, and multicomponent strategies that include audit and feedback are effective in reducing overuse. 47 Rising patient demand and utilisation, resource constraints and resultant capacity strain threaten the sustainability of the Australian acute hospital system. Minimising the substantial overuse of care documented in this review would go some way in allowing more of the limited resources available to be directed towards interventions that are of proven effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Audit‐based measures of overuse of medical care in Australian hospital practice

Scott

2019

Internal Medicine Journal

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Overuse of care that does not confer benefit to patients and wastes limited resources is being increasingly recognised as a major healthcare problem. The preferred measure of overuse of a specific intervention is applying an evidence‐ or consensus‐based measure of inappropriateness directly to the medical records of individual patients who have received the intervention. This study aimed to assess the extent of overuse of care in hospital practice in Australia based on peer‐reviewed literature that reported clinical audits using explicit measures of overuse applied to patient‐level clinical data. Thirty‐five studies met selection criteria, 14 relating to investigations, 21 to management strategies. Overuse rates above 30% were reported for coagulation tests, blood cultures, troponin assays, abdominal imaging studies, use of telemetry, blood product infusions, polypharmacy in older patients, prescriptions for various medications (gastric acid suppressants, direct oral anticoagulants, inhaled corticosteroids), admissions for low‐risk chest pain and futile interventions in end of life care. Hospital physicians may need to audit their current high‐volume practices and ensure they align with current criteria of appropriateness.

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Palliative care in cirrhosis with decompensation

Cited by 9 publications

References 22 publications

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

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

Deaths from hepatocellular carcinoma are more likely to occur in medical facilities than deaths from other cancers: 2003‐2018

Audit‐based measures of overuse of medical care in Australian hospital practice

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