Hospice for the Terminally Ill and End-of-Life Care

When and How Should Physicians Determine the Need for Palliative and Hospice Care for Patients With End-Stage Liver Disease?

“…18 In addition, despite guidelines, physicians often refer patients to hospice care late, and earlier referrals when patients may reasonably have 6 months to live would maximize hospice resources. 3,5,7,8 Why is hospice a last-minute strategy? Many barriers to physicians recommending hospice care may originate within the physicians themselves.…”

“…Generally, a 6-month median survival is associated with the presence of 2 to 4 of these factors, for example, terminal illness presentation for hepatic disease (cirrhosis) has been specified as decompensated hepatic cirrhosis with a Child-Pugh score of 12 and/or the Model for End-stage Liver Disease (MELD) score of 21. 7,8 Chen et al demonstrated that high MELD scores at the time of rebleeding were independent predictors for 6-week mortality; the cutoff value of 21.5 showed acceptable sensitivity and specificity to predict 6-week mortality. 6 Palliative care is a service intended to improve the dying experience in hospitals and nursing homes, and palliative care consultation is also available from specialists within some institutions.…”