P15 Priorities in relapse prevention for patients with alcohol related cirrhosis: a national expert consensus building study

<h3>Background</h3> Alcohol use is the primary determinant of outcome for patients following a hospital admission with decompensated alcohol related cirrhosis. It is vital therefore to determine the best ways to support patients in remaining abstinent. <h3>Methods</h3> The study was conducted remotely using online software. Initially a short survey was conducted of stakeholders. These included specialists in hepatology and alcohol use disorder as well as individuals with lived experience of alcohol related cirrhosis and their carers. We asked about the facilitators and barriers to abstinence following a hospital admission. An expert Steering Group which included mmbers with lived experience examined the survey results and integrated this with other sources of evidence to produce a list of potential recommendations to optimise relapse prevention. The expert stakeholders were then asked to review each recommendation and rate their agreement with the statement ‘This recommendation should be prioritised’. Recommendations which reached consensus (&gt;70% agreement) went through to a ranking process. Finally, ranked responses were weighted so that recommendations given a top rank received more points. <h3>Results</h3> 188 stakeholders engaged with this study, including 33 who identified as having lived experience of alcohol related cirrhosis. A wide range of themes were identified including pharmacotherapies, social circumstances, mental health and provision of services. 48 recommendations were generated by the steering panel. 37 recommendations achieved consensus from stakeholders. At the ranking stage the following 5 recommendations achieved the highest ranking scores. Four out of these 5 recommendations also appeared in the top 5 for participants with lived experience. Relapse prevention work should be presented as a routine part of the care of patients with alcohol related cirrhosis. Patients should be therefore required to opt-out rather than opt-in to relapse prevention work. Patients should be offered medications for alcohol use disorder prior to discharge. Before discharge from hospital patients should be provided with clear information about their liver disease and the risks of future alcohol use in a manner that they can understand. Community alcohol services should see patients within two weeks of discharge. Patients should be directly referred by the hospital team for relapse prevention treatment rather than having to self-refer. <h3>Conclusion</h3> Stakeholders identified that relapse prevention, including the use of pharmacotherapies, clear information, and prompt follow-up, should be prioritised as routine standard of care for all patients with alcohol related cirrhosis.