COMPASS: A Pilot Trial of an Early Palliative Care Intervention for Patients With End-Stage Liver Disease

Shinall, Myrick C.; Karlekar, Mohana; Martin, Sara; Gatto, Cheryl L.; Misra, Sumathi; Chung, Chan Y.; Porayko, Michael K.; Scanga, Andrew; Schneider, Natasha J.; Ely, E. Wesley; Pulley, Jill M.; Jerome, Rebecca N; Dear, Mary Lynn; Conway, Douglas; Buie, Reagan; Liu, Dandan; Lindsell, Christopher J.; Bernard, Gordon R.

doi:10.1016/j.jpainsymman.2019.06.023

Cited by 44 publications

(41 citation statements)

References 20 publications

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“…MBSR was also effective in improving social well‐being for patients with DC in these small studies. ( 45 , 55 , 56 )…”

Section: Resultsmentioning

confidence: 99%

“…MBSR was also effective in improving social well-being for patients with DC in these small studies. (45,55,56) Case stuDy, paRt 2 A few months later, Mr. Smith is admitted for an esophageal variceal bleed and receives successful band ligation in the intensive care unit (ICU). He is discharged home for a brief period but develops peritonitis, requiring a prolonged course of intravenous antibiotics.…”

Section: Pain and Physical Symptomsmentioning

confidence: 99%

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Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

et al. 2021

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Individuals with advanced liver disease (AdvLD), such as decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC), have significant palliative needs. However, little research is available to guide health care providers on how to improve key domains related to palliative care (PC). We sought to identify priority areas for future research in PC by performing a comprehensive literature review and conducting iterative expert panel discussions. We conducted a literature review using search terms related to AdvLD and key PC domains. Individual reviews of these domains were performed, followed by iterative discussions by a panel consisting of experts from multiple disciplines, including hepatology, specialty PC, and nursing. Based on these discussions, priority areas for research were identified. We identified critical gaps in the available research related to PC and AdvLD. We developed and shared five key priority questions incorporating domains related to PC. Conclusion: Future research endeavors focused on improving PC in AdvLD should consider addressing the five key priorities areas identified from literature reviews and expert panel discussions. (Hepatology Communications 2021;0:1-12).

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“…MBSR was also effective in improving social well‐being for patients with DC in these small studies. ( 45 , 55 , 56 )…”

Section: Resultsmentioning

confidence: 99%

Section: Pain and Physical Symptomsmentioning

confidence: 99%

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

et al. 2021

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“…Thirdly, health economic data were missing from one site (17% of participants) and the small sample resulted in substantial range in costs, hence data need be interpreted with caution. Finally, we recruited only 75% of our target sample size, consistent with an earlier palliative trial in ESLD 46 …”

Section: Discussionmentioning

confidence: 99%

Randomised clinical trial: palliative long‐term abdominal drains vs large‐volume paracentesis in refractory ascites due to cirrhosis

Macken¹,

Bremner²,

Gage

et al. 2020

Aliment Pharmacol Ther

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Summary Background Palliative care remains suboptimal in end‐stage liver disease. Aim To inform a definitive study, we assessed palliative long‐term abdominal drains in end‐stage liver disease to determine recruitment, attrition, safety/potential effectiveness, questionnaires/interview uptake/completion and make a preliminary cost comparison. Methods A 12‐week feasibility nonblinded randomised controlled trial comparing large‐volume paracentesis vs long‐term abdominal drains in refractory ascites due to end‐stage liver disease with fortnightly home visits for clinical/questionnaire‐based assessments. Study success criteria were attrition not >50%, <10% long‐term abdominal drain removal due to complications, the long‐term abdominal drain group to spend <50% ascites‐related study time in hospital vs large‐volume paracentesis group and 80% questionnaire/interview uptake/completion. Results Of 59 eligible patients, 36 (61%) were randomised, 17 to long‐term abdominal drain and 19 to large‐volume paracentesis. Following randomisation, median number (IQR) of hospital ascitic drains (long‐term abdominal drain group vs large‐volume paracentesis group) were 0 (0‐1) vs 4 (3‐7); week 12 serum albumin (g/L) and serum creatinine (μmol/L) were 29 (26.5‐32.5) vs 30 (25‐35) and 104.5 (81‐115.5) vs 127 (63‐158) respectively. Total attrition was 42% (long‐term abdominal drain group 47%, large‐volume paracentesis group 37%). Median (IQR) fortnightly community/hospital/social care ascites‐related costs and percentage study time in hospital were lower in the long‐term abdominal drain group, £329 (253‐580) vs £843 (603‐1060) and 0% (0‐0.74) vs 2.75% (2.35‐3.84) respectively. Self‐limiting cellulitis/leakage occurred in 41% (7/17) in the long‐term abdominal drain group vs 11% (2/19) in the large‐volume paracentesis group; peritonitis incidence was 6% (1/17) vs 11% (2/19) respectively. Questionnaires/interview uptake/completion were ≥80%; interviews indicated that long‐term abdominal drains could transform the care pathway. Conclusions The REDUCe study demonstrates feasibility with preliminary evidence of long‐term abdominal drain acceptability/effectiveness/safety and reduction in health resource utilisation. Trial registration: ISRCTN30697116, date assigned: 07/10/2015.

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“…SPC has been associated with fewer hospital readmissions to the hospital in patients with ESLD (11)(12)(13) and, for patients who ultimately die, with lower use of life-sustaining treatments, shorter lengths of stay, (14,15) greater reductions in their health care utilization, and higher rates of advance care planning. (16) Despite these benefits, involvement of SPCs in the United States is relatively uncommon, with less than one-third of hospitalized, ESLD patients receiving such services.…”

Section: Specialty Palliative Care Is Underutilized In Hospitalized Pmentioning

confidence: 99%

“…Using the CANONIC study definition, ACLF is defined as the presence of OFs in patients with DC associated with high short‐term mortality. ( 12 ) ACLF is different from “mere” acute decompensation without OF, or, in which OFs do not meet ACLF criteria and is associated with lower short‐term mortality. ( 8 ) ACLF can be further classified according to the number of OFs: ACLF‐1 (one OF), ACLF‐2 (two OFs), or ACLF‐3 (three or more OFs).…”

Section: Aclf Is a Dynamic Syndrome Associated With Poor Outcomesmentioning

confidence: 99%

Considerations for Prognosis, Goals of Care, and Specialty Palliative Care for Hospitalized Patients With Acute‐on‐Chronic Liver Failure

et al. 2020

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COMPASS: A Pilot Trial of an Early Palliative Care Intervention for Patients With End-Stage Liver Disease

Cited by 44 publications

References 20 publications

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

Randomised clinical trial: palliative long‐term abdominal drains vs large‐volume paracentesis in refractory ascites due to cirrhosis

Considerations for Prognosis, Goals of Care, and Specialty Palliative Care for Hospitalized Patients With Acute‐on‐Chronic Liver Failure

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