The LiverCare intervention: implementing structured palliative care in hepatology - a multicenter mixed-methods feasibility study in patients with cirrhosis.

BACKGROUND: Liver cirrhosis is associated with high symptom burden, psychological distress, and substantial unmet supportive care needs. Although early palliative care improves outcomes in other serious diseases, it remains under integrated in hepatology. This study evaluated the feasibility of a structured palliative care intervention for patients with cirrhosis and their informal caregivers. METHODS: LiverCare is a multicenter, mixed-methods feasibility study conducted across four Danish hepatology departments. Eligible patients were identified using the Supportive and Palliative Care Indicators Tool. The intervention comprised structured, repeated palliative care conversations delivered by trained hepatologists and liver nurse specialists alongside routine clinical care. Between August 2023 and July 2024, 42 patients and 25 informal caregivers were enrolled. Outcomes included anxiety, depression, quality of life, caregiver burden, and qualitative interviews. Feasibility was evaluated using the RE-AIM framework. RESULTS: Of 68 eligible patients, 42 were enrolled (62%). All completed the first conversation; 27 and 12 completed the second and third conversations, respectively. Patient-reported outcomes on anxiety, depression, and quality of life remained stable during follow-up. Caregiver burden decreased over time. Qualitative findings demonstrated enhanced communication, emotional validation, and facilitated future care planning. Across all conversations, 128 clinical actions were initiated. The intervention was delivered with high fidelity and was perceived as relevant and meaningful. CONCLUSIONS: Structured palliative care integrated within hepatology was feasible and acceptable and was associated with reduced caregiver burden. These findings support further evaluation in a larger controlled study and inform implementation of palliative care in advanced liver disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT05431946, registered 24 June 2022.