‘Liver Supportive Care’ is a multidisciplinary approach that integrates palliative care into the multidisciplinary team involved in the management of chronic liver disease, in order to improve the care of patients with chronic, end-stage liver disease with palliative care needs.

There is a growing body of evidence to support the integration of palliative care for patients with the growing burden of chronic liver disease and related complications, in particular patients with End Stage Liver Disease. Available evidence dictates that integration of health specialties with palliative care is associated with improved health outcomes including improved quality of life, quality of life care, decreased rates of depression, improved understanding of illness and improved patient satisfaction.^1-3

We describe a new, embedded model of care at St George Hospital, Sydney. Patients who meet referral criteria (based on modified-SPICT criteria) with cirrhotic liver disease and/or HCC without curative intent, are referred to the Liver Supportive Care service. This encompasses a co-located clinic each week, with a Multi-Disciplinary team approach involving a Palliative Care Physician (0.4FTE), Hepatologist, CNCs, Dietician and Social Worker. There is also a ward consult service which sees patients known to the service and accepts new referrals, who can then be followed up in the Outpatient Clinic on discharge. The service aims to manage symptoms of end stage liver disease, which are numerous and severe3 and then seamlessly transfer patients to the community team for end of life care. Preliminary statistics show that over the 14 months from February 2023 to April 2024, we received 87 referrals to the service. There were 134 inpatient occasions of service, and 201 outpatient occasions of service.

68 patients had a diagnosis of HCC (with or without pre-existing cirrhotic liver disease), 20 had non-malignant cirrhotic liver disease, and 2 had cholangiocarcinoma. At time of submission, 41 patients had died and 10 had been discharged (1 due to successful transplantation). Of those who died, the mean time of referral to death was 72 days (range 3 – 322 days) with the majority (90.3%) expected and appropriately planned for. Just under half of the deaths occurred in a Palliative Care Unit, and 41.4% were known to the Community Palliative Care Team prior to death. Only 2 patients died without an Advance Care Plan in place, both of whom were referred at the beginning of the service.

References

1. Temel J S et al. Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal. 2010.

2. Hui, D & Bruera, E. Models of integration of oncology and palliative care. Annals of Palliative Medicine.2015.

3. Potosek MD et al. Integration of palliative care in end stage liver disease and liver transplantation. Journal of Palliative Medicine. 2014.