Living and dying with advanced chronic liver disease in the UK: a multicentre cohort study of palliative care provision and associated factors

Objective Palliative care (PC) can reduce symptoms and resource use in decompensated advanced chronic liver disease (dACLD), yet is often underused. This study describes current practices and factors linked to increased PC use for patients who died from dACLD in the UK. Methods We conducted a retrospective, multicentre cohort study of adults who died of dACLD between 1 January and 30 June 2022 and had a non-terminal admission in their last year of life (LYOL). Patient and service-level data were collected. The primary outcomes were use of established PC interventions, namely (1) poor prognosis discussion, (2) advance care planning (ACP) and (3) specialist palliative care (SPC) referral. A multivariable logistic regression model identified factors associated with increased utilisation of PC interventions. Results Data from 803 patients across 85 hospitals showed a median of three admissions and 30 inpatient days in the LYOL. Poor prognosis discussions and ACP occurred for 49.9% and 36.9% of patients, respectively. Inpatient SPC referrals were made for 49.6% (79.1% during a terminal admission) and outpatient SPC referrals for 17.6%. On multivariable analysis, three variables were significantly associated with increased utilisation of one or more PC interventions: (1) Use of an objective prognostic score, (2) Documentation of suitability for transplant and (3) ACLD multidisciplinary team (MDT) discussion. Conclusions Patients with dACLD infrequently receive PC interventions, despite multiple healthcare attendances. SPC was typically limited to a late stage, reflecting missed opportunities for holistic care. Routine, objective assessment of prognosis and MDT management may increase PC interventions in patients with dACLD.