World Congress at ACG2017
Simultaneous Plenary Session 4A: Liver
54 - Palliative Care in Cirrhosis: Role of Transitional Care Liver Clinic
Wednesday, October 18
8:40 AM - 8:50 AM
Location: Valencia Ballroom BC (Level 4)
Category: Practice Management
Nilofar Najafian, MD1, Jordan Sack, MD1, Angela DeLisle, MHS, PA-C2, Sofia Simona Jakab, MD1
1Yale University School of Medicine, New Haven, CT; 2Yale New Haven Health, New Haven, CT
Introduction: Palliative care (PC) is underutilized in patients with cirrhosis and data regarding PC delivery for patients with cirrhosis is limited. Transitional care clinics provide PC in end-stage diseases such as heart failure. In March 2015, we opened a transitional care liver clinic (TCLC) to expedite outpatient follow up and to improve continuity of care in non-transplant eligible patients with cirrhosis admitted to the inpatient liver service. The aim of this study was to evaluate the use of PC for patients seen in our TCLC and to identify potential interventions.
Methods: This is a retrospective review of non-transplant eligible patients with cirrhosis discharged from the inpatient liver service and scheduled in the TCLC of a university health system from March 2015 to December 2015, with follow-up through December 2016. Patients who died within 1 year from the first visit in TCLC were included. We collected data on patient characteristics (cirrhosis etiology, MELD/CTP score, readmissions), goals of care discussion during TCLC visits, use and timing of PC consults, use of hospice, and if death occurred in the hospital.
Results: 18 of 58 patients who showed for the first TCLC visit died within 1 year (31%), 10 of them while in the hospital (56%). The majority were men (72%), mean age 56 (range 36-74), with decompensated cirrhosis (100%), mostly alcoholic cirrhosis (72%). 11 of 18 patients (61%) had at least 2 readmissions between TCLC and death, and 9 of 18 patients (50%) were readmitted within 30 days. There was no discussion about PC in any TCLC visits. PC was consulted during hospitalization in 10 of 18 patients (56%), 3 of those 10 patients died in the hospital versus 7 of 8 patients without PC consult (30% v 88%, p=0.02). PC consults were requested within 2 weeks prior to death in 6 of these 10 patients (60%). 4 of 5 patients with malignancy had PC consults versus 6 of 13 patients with no malignancy (80% v 46%, p=0.31).
Discussion: There was insufficient use of PC in patients with cirrhosis. The vast majority of our patients without PC involvement died in the hospital. The availability of outpatient PC remains limited in many healthcare systems, especially for patients with no malignancy. We propose taking advantage of TCLC as a perfect opportunity to introduce patients with decompensated cirrhosis to the role of palliative care, and considering PC consult for patients readmitted within 30 days or with more than 2 readmissions.
Supported by Industry Grant: No
Citation: . PALLIATIVE CARE IN CIRRHOSIS: ROLE OF TRANSITIONAL CARE LIVER CLINIC. Program No. 54. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.