Palliative Care for Advanced Liver Disease: Hepatology and Palliative Care Specialists Experiences.

CONTEXT: People with advanced liver disease (ALD) face progressive symptoms and may benefit from palliative care (PC); but optimal care models remain unknown.

OBJECTIVES

To describe PC-trained hepatologists and board-certified PC specialists experiences with integrating PC into ALD care.

METHODS

We conducted an embedded qualitative evaluation study, within the 19-site, randomized PAL-LIVER comparative effectiveness trial, to understand clinicians' perspectives on providing integrated PC in ALD. Semi-structured interviews, conducted between March 23, 2020, and July 1, 2022, were transcribed verbatim, coded, and analyzed to generate themes about their experiences.

RESULTS

Clinicians (17 = hepatologists; 15 = PC providers) with mean age (SD) of 47.3 (8.8) years, 65.3% women, 78.1% White, 68.4% physicians, and 25% nurse practitioners; 43.7 % had been in practice ≤10 years. Shared themes included: 1) Cross-disciplinary primary PC and ALD education is central to PC integration; and 2) Providing PC takes time. Hepatologists unique themes were: 1) Navigating the intersection of primary and specialty PC, and 2) Increased awareness of caregivers' needs. PC specialists' unique themes were: 1) Misperceptions of PC, and 2) Characteristics of hepatology-palliative collaborations.

CONCLUSIONS

Future PC implementation into routine ALD care will require cross-disciplinary education, adjustments to hepatologists clinical schedules to allocate time to assess and address patient and caregiver PC needs and to discern which patients are best managed by a trained hepatologist vs a PC specialist. On-going misperceptions about the purpose of PC were addressed and facilitated by interdisciplinary collaboration. Our results will guide future efforts to scale PC integration into routine ALD management.

CLINICALTRIALS: gov NCT03540771.