Patients with advanced liver disease have significant symptom and psychological burdens. Palliative care can improve symptoms and quality of life. Timely advance care planning (ACP) allows patients to prepare for deterioration and facilitate patients dying in the place of their choice.

Method Collaborative working between the Macmillan Supportive and Palliative Care Team (SPCT) and Gastroenterology colleagues developed a Supportive and Palliative Care Liver Service (SPCLS) to meet the needs of patients with advanced liver disease. SPCT engaged with doctors and nursing staff; discussing the service and referral criteria. SPCT joined Gastroenterology ward rounds, alongside joint working between the Alcoholic Liver Disease Clinic and SPCT Clinic. A retrospective audit looked at inpatient referrals to the SPCT for 19 liver disease patients before and 22 patients after the SPCLS.

Results

• Prior to the SPCLS 68% of patients referred were in the last days of life at time of referral or had a poor prognosis, this reduced to 23% after the service started. As a consequence most patients (63%) were unable to discuss ACP whilst with the SPCLS 73% could discuss ACP.

• Prior to the SPCLS in only 21% of cases did the referring ward team recognise and refer their patients for symptom control, compared with 68% of patients referred for symptom control after the service started.

• Since the SPCLS started the percentage of patients who received psychological support increased from 53% to 73%.

• Since the SPCLS started the percentage of non–cancer patients referred to the SPCT dying in hospital reduced from 90% to 50%.

Conclusion SPCLS has facilitated patients being referred to SPCT earlier in their illness; there is an improved awareness of symptoms and the role of SPCT. Earlier referral enabled more patients to discuss ACP and receive psychological support. Since the development of the SPCLS fewer patients died in hospital.