Background The incidence of liver disease is increasing year on year coupled with increasing mortality. Death from liver disease may be sudden but is often preceded by a prolonged period of ill health where the opportunity to explore end of life preferences could be discussed, but often isn’t. Patients with advanced liver disease often have a high symptom burden impacting significantly on their quality of life. This is often coupled with complex psychosocial circumstances which would benefit from a holistic approach to care. A local need to try and improve access for these patients to palliative care services was identified.
Method A fortnightly Advanced liver disease multidisciplinary team (MDT) meeting was established lead by a Hepatology consultant, Hepatology nurse consultant and a Palliative Care Consultant. Other members of the MDT include an MDT coordinator, Alcohol nurse specialist, Hepatic encephalopathy nurse specialist and MDT coordinator. A referral process was developed and outcomes from the MDT recorded to allow retrospective analysis of interventions.
Results Preliminary outcome data has shown:
Increased proportion of patients with advanced liver disease engaging with palliative care services in comparison to a year ago
Increased number of patients with advanced liver disease dying in places other than hospital – home, hospice or nursing home
Increased confidence within the hepatology team in opening up difficult conversations and advance care planning
Increased confidence within palliative care professionals in managing patients with advanced liver disease
Conclusion Collaborative working between hepatology and palliative care is essential in improving care for patients with advanced liver disease. Joint multidisciplinary team meetings have been shown to increase appropriate referrals for patients therefore increasing engagement with palliative care services. This model has also provided reciprocal learning between teams to increase knowledge, skills and confidence in the opposite specialty whilst building excellent working relationships between teams.
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