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Abstract
Background Advanced liver disease is the second leading cause of premature mortality. With high symptom burden, frequent hospital admissions and poor quality of life, this patient cohort has substantial palliative care needs. Early provision of palliative care can lead to improvements in physical and psychological symptom burden and reduced health-care use. Prior to March 2020 a joint (Palliative Care/Gastroenterology) monthly advanced liver clinic existed at our hospice.
Aim To provide early specialist palliative care (SPC) intervention for patients with advanced liver disease.
Method The pandemic forced a natural temporary closure of this face-to-face clinic. Review of data from this clinic demonstrated: Late referral to the SPC team; High non-attendance rates; Lack of flexibility regarding SPC clinical review. This led to the need for a different approach to support this patient cohort. Between 2020–2022 direct referrals to the SPC community medical team increased and specialist liaison was supported by the new IT developments that we all witnessed in the pandemic. In 2023 an advanced liver disease MDT was established between the hospital-based gastroenterology team and the SPC team at the hospice. Currently bi-weekly virtual meetings discuss new referrals to SPC, obtain patient management advice from the specialist colleagues and update on shared-care patients.
Results This service development has so far:
Facilitated regular meetings and additional liaison between the two specialties.
Increased referral rates to SPC.
Improved referral process into SPC services.
Decreased the waiting time from referral to clinical review by SPC teams.
Supports recent NICE guidance – mandatory to discuss the consideration of an indwelling peritoneal catheter (pleurX) at an MDT.
Conclusion Symptom burden in advanced liver disease is high. An advanced liver disease MDT provides opportunity to identify and discuss the supportive care needs of patients, establish reasonable ceilings of care, and clarify management plans.