Introduction The prospect of dying is a difficult subject to broach with patients and their relatives. This is exacerbated in patients with liver cirrhosis. We raised the question whether we were communicating with patients and their relatives.

Methods We assessed the notes of patients who had ‘cirrhosis’ or ‘liver disease’ documented on their death certificates during April- September 2019. This included reviewing all documentation during admissions and clinic attendances focusing on whether prognosis or the risks of dying were discussed. We analysed multiple prognostic indicators to assess if we were recognising these and relaying this to the patient and their next of kin.

Results We reviewed the notes of 19 patients. The mean age of death was 60 years. 84% of patients died in hospital with mean length of stay of 13 days. 69% of patients had no discussion about cirrhosis and its life limiting implications documented prior to the last admission. 1 patient had a discussion about palliative care options. 43% of relatives had a discussion documented before the last admission. During the final admission 29% patients had a discussion documented, 67% of relatives had a discussion documented with 55% of discussions being done by gastroenterology. Do not attempt resuscitation forms were in place in 84% at the time of death. 3 patients were referred to palliative care. 68% of the patients had indicators suggesting a mortality more than 81% within 1 year.¹

Conclusions We are not relaying to the patient or relatives that liver cirrhosis is a life limiting condition. We are preventing advanced care planning and access to palliative care. Open, honest discussions need to take place in a timely manner. Every patient interaction should be seen as an opportunity for these discussions to take place due to unpredictable nature of cirrhosis.

Reference

1. Hudson BE, Ameneshoa K, Gopfert A, et al. Integration of palliative and supportive care in the management of advanced liver disease: development and evaluation of a prognostic screening tool and supportive care intervention. Frontline Gastroenterol 2017;8(1):45–52.