Open AccessPalliative Care and Hospice Referrals in Patients with Decompensated Cirrhosis: What Factors Are Important?
Author(s) -
John Holden,
Hani Shamseddeen,
Amy W. Johnson,
Benjamin Byriel,
Kavitha Subramoney,
YaoWen Cheng,
Akira Saito,
Marwan Ghabril,
Naga Chalasani,
Greg A. Sachs,
Eric S. Orman
Publication year - 2020
Publication title -
journal of palliative medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.986
H-Index - 90
eISSN - 1096-6218
pISSN - 1557-7740
DOI - 10.1089/jpm.2019.0501
Subject(s) - medicine , referral , palliative care , cirrhosis , alcoholic liver disease , retrospective cohort study , ascites , liver disease , cohort , hepatocellular carcinoma , comorbidity , end of life care , emergency medicine , family medicine , nursing
Background: Palliative care (PC) and hospice care are underutilized for patients with end-stage liver disease, but factors associated with these patterns of utilization are not well understood. Objective: We examined patient-level factors associated with both PC and hospice referrals in patients with decompensated cirrhosis (DC). Design: Retrospective cohort study. Setting/Subjects: Patients with DC hospitalized at a single tertiary center and followed for one year. Measurements: We assessed PC and hospice referrals during follow-up and examined patient-level factors associated with the receipt of PC and/or hospice, as well as associated clinical outcomes. We also examined late referrals (within one week of death). Results: Of 397 patients, 61 (15.4%) were referred to PC, 71 (17.9%) were referred to hospice, and 99 (24.9%) were referred to PC and/or hospice. Two hundred patients (50.4%) died during the one-year follow-up. In multivariable logistic regression, referral to PC was associated with increased comorbidity burden, ascites, increased MELD (Model for End-Stage Liver Disease)-Na score, lack of listing for liver transplant, and unmarried status. Hospice referral was associated with increased comorbidities, portal vein thrombosis, and hepatocellular carcinoma. PC referrals were late in 68.5% of cases, and hospice referrals were late in 62.7%. Late PC referrals were associated with younger age and married status. Late hospice referrals were associated with younger age and recent alcohol use. Conclusions: PC and hospice is underutilized in patients with DC, and most referrals are late. Patient-level factors associated with these referrals differ between PC and hospice.