P66 Review of palliative care in patients admitted with decompensated cirrhosis to South Tyneside and Sunderland NHS Foundation Trust over a 12-month period

<h3>Introduction</h3> Decompensated cirrhosis is associated with a high morbidity and mortality, with a median survival of just 2 years.¹ Although it is well recognised that patients with decompensated cirrhosis have significant palliative care needs, these are frequently inadequately addressed.^{2 3} Admissions with decompensated cirrhosis represent an opportunity to provide palliative care for these patients, including initiating advance care planning.^{2 4} <h3>Methods</h3> A retrospective review of all admissions with decompensated cirrhosis to South Tyneside and Sunderland Foundation Trust over a 12-month period from September 2022 to 2023 was conducted. Data was collected for all patients over the age of 18 years who had an unplanned emergency admission with decompensated cirrhosis in this period. Four factors were identified as markers of palliative care during admission: specialist palliative care team referral or input; any advance care planning during admission; Emergency Health Care Plan (EHCP) in place at time of discharge; and DNACPR in place during admission. <h3>Results</h3> A total of 149 patients with decompensated cirrhosis were admitted to South Tyneside and Sunderland Hospital NHS Foundation Trust over the 12-month period. Overall mortality was 28.75% with an average MELD score of 21 (range 8–50). 9 patients (6.04%) had specialist palliative care referral or input during their admission. 6 patients (4.04%) had any advance care planning during their admission and 4 patients (2.68%) had an EHCP in place at the time of discharge. 54 patients (36.24%) patients had an DNACPR in place during their admission. Out of the patients with the most severe disease, defined as a MELD score over 30 (12 patients), there was a mortality rate of 83.3% (10). Within this cohort, there was no evidence of any advance care planning, although one of these patients did already have an EHCP in place. Out of this cohort, 75% (9) of patients had a DNACPR and only one patient had any specialist palliative care input. <h3>Discussion</h3> This review showed a low rate of palliative care for patients with decompensated cirrhosis admitted to South Tyneside ad Sunderland NHS Foundation Trust over a 12-month period, which was particularly marked for the cohort with the most severe disease. The lack of advance care planning in patients with the most severe disease is likely to have been affected by the very high mortality rate in this cohort, although there was also no advance care planning for the patients who survived to discharge from this cohort. <h3>References</h3> Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, Krag A, Laleman W, Gines P. ‘EASL clinical practice guidelines for the management of patients with decompensated cirrhosis’.<i> Journal of Hepatology.</i> 2018;<b>69</b>(2):406–460. Woodland H, Hudson B, Forbes K, McCune A, Wright M. ‘Palliative care in liver disease: what does good look like?’ <i>Frontline Gastroeneterology</i>. 2019;<b>11</b>(3):218–227. Langberg KM, Kapo JM, Taddei TH. ‘Palliative care in decompensated cirrhosis: a review’ Liver International. 2018;<b>38</b>(5):768–775. Phillips CA, Kedarisetty CK. Palliative care for patients with end-stage liver disease.<i> Journal of Clinical and Experimental Hepatology.</i> 2023;<b>13</b>(2):319–328.