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P-172 Integration of palliative care in the management of advanced liver disease
  1. Nikki Reed1,2 and
  2. Alexandra Daley2
  1. 1Marie Curie Hospice West Midlands, UK
  2. 2University Hospitals of Birmingham NHS Foundation Trust (HGS), Birmingham, UK


Background Between 1970 and 2010 the mortality rate for people dying with liver disease increased by 400%. It is now the third most common cause of death in working-aged adults (18–65 years). This has resulted in a significant pressure on acute hospital services. Most patients with decompensated cirrhosis rarely receive palliative care intervention despite the significant symptom burden. It has been recognised that palliative care intervention improves symptoms, mood and quality of life in patients with advanced liver disease.

Aim To improve local access to palliative care services for patients with advanced non-malignant liver disease.

Method In early 2017 collaborative working between the hospice-based Consultant in Palliative Care and the acute hospital-based Consultant Gastroenterologist commenced. In October 2017 a combined liver clinic was commenced at the hospice with patients being reviewed by both gastroenterology and palliative care.

Results Although the monthly liver clinic is still in a very early phase our SystmOne data has demonstrated:

  • Three patients with advanced non–malignant liver disease were referred for our palliative care services in the two years 2015–2016

  • 15 patients with advanced non–malignant liver disease referred for our palliative care services for the two years 2017–2018 (still six months to go).

The majority of these referrals have been for outpatient clinic, however, direct referrals to the inpatient unit have increased as well.

Conclusion The increase in our referral numbers correlates with the start of our collaboration with the acute gastroenterology team. The need to improve end of life care for patients with liver disease has been recognised internationally. The huge symptom burden that these patients experience needs specialist palliative care input. We hope that our local collaboration will continue to help to address the inequality of access to our services for this group of patients.

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