Palliative Care Trends in Patients With End-Stage Liver Disease


A study published in Hepatology conducted a retrospective analysis of patients with end-stage liver disease (ESLD) and found low rates of referral for palliative care as well as demographic barriers that may hinder access to these services.

As palliative care services have been historically underutilized in this population, researchers Mayur Brahmania, MD, University Health Network (Toronto, ON) and colleagues studied data from the Nationwide Inpatient Sample (NIS). The NIS includes about 20% of all in-patient hospitalizations from 46 states.
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The analysis included all patients > 18 years old admitted with ESLD, which was defined as those having at least two liver decompensation events. In the sample, there were 55,208,382 hospitalizations from a 2006-2012 NIS sample, with 39,349 patients meeting the inclusion criteria (2017; doi:10.1002/hep.29297).

Authors found that 1,789 (4.5%) of patients with ESLD received palliative care consultations. The rate of referral for palliative care increased from .97% in 2006 to 7.1% in 2012 (P < .01). Lower socioeconomic status and Hispanic race were two factors linked with lower palliative care referrals.

Dr Brahmania said in an article, “The current study is one of the largest nationwide studies of palliative care referral in patients with end-stage liver disease. Although palliative care referrals in patients with end-stage liver disease is increasing, the rate of referrals is still very low…. We must emphasize that palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness” (June 29, 2017. Medical Xpress).—Amanda Del Signore