Palliative care access for hospitalized patients with end‐stage liver disease across the United States

Rush, Barret; Walley, Keith R.; Celi, Leo Anthony; Rajoriya, Neil; Brahmania, Mayur

doi:10.1002/hep.29297

Cited by 81 publications

(62 citation statements)

References 33 publications

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“…Teaching hospitals are likely to have an established integrated palliative care system and higher availability of specialist palliative care services 49. Further studies are needed to achieve equity of access to specialist palliative care and adequate care transfer between different clinical settings for people with ILD.…”

Section: Resultsmentioning

confidence: 99%

Barriers to specialist palliative care in interstitial lung disease: a systematic review

Kim

Atkins

Wilson

2018

BMJ Support Palliat Care

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BackgroundCurrent guidelines recommend palliative care based on individual needs for patients with idiopathic pulmonary fibrosis. However, patients with interstitial lung disease (ILD) are less likely to receive specialist palliative care services compared with patients with malignant disease. The aim of this review is to summarise recent studies addressing barriers to referring patients to specialist palliative care services.MethodsPubMed, Embase, Medline and Web of Science were reviewed to identify relevant publications. Studies were selected if they examined the frequency of specialist palliative care referral and/or addressed issues surrounding access to palliative care services for patients with ILD.ResultsTen studies with a total of 4073 people with ILD, 27 caregivers and 18 healthcare professionals were selected and analysed. Frequency of palliative care referrals ranged from 0% to 38%. Delay in palliative care referrals and end-of-life decisions, patients’ fear of talking about the future, prognostic uncertainty and confusion about the roles of palliative care were identified as barriers to accessing palliative care services.ConclusionFurther research should concentrate on the early identification of patients who need specialist palliative care possibly with establishment of criteria to trigger referral ensuring that referrals are also based on patient’s needs.

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Section: Resultsmentioning

confidence: 99%

Barriers to specialist palliative care in interstitial lung disease: a systematic review

Kim

Atkins

Wilson

2018

BMJ Support Palliat Care

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“…Other retrospective studies showed that only 1 in 3 terminally hospitalized patients received PC consultation, with lower rates among LT candidates and racial or ethnic minorities . Overall, only 5% of all hospitalized patients with multiple cirrhosis decompensations had documented PC consultations, and these patients rarely received a PC referral outside of the hospital, with nearly 90% of 1 transplant center’s PC referrals occurring during a hospital admission …”

Section: The Benefits Of Pc In Esldmentioning

confidence: 99%

“…These shortcomings may be exaggerated among LT candidates with early goals‐of‐care discussions for these patients occurring at half the rate of LT noncandidates (20% versus 40%) . Those receiving care at larger hospitals or with an existing do‐not‐resuscitate order or a diagnosis of cancer (HCC or metastatic disease) are more likely to receive PC …”

Section: The Benefits Of Pc In Esldmentioning

confidence: 99%

Current Knowledge, Barriers to Implementation, and Future Directions in Palliative Care for End‐Stage Liver Disease

Fricker

Serper

2019

Liver Transpl

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End‐stage liver disease (ESLD) is associated with a high degree of morbidity and mortality as well as symptom burden. Despite this, the rate of consultation with palliative care (PC) providers remains low, and invasive procedures near the end of life are commonplace. Studies show that involvement of PC providers improves patient satisfaction, and evidence from other chronic diseases demonstrates reduced costs of care and potentially increased survival. Better integration of PC is imperative but hindered by patient and provider misconceptions about its role in the care of patients with ESLD, specifically among candidates for liver transplantation. Additionally, reimbursement barriers and lack of provider knowledge may contribute to PC underutilization. In this review, we discuss the benefits of PC in ESLD, the variability of its delivery, and key stakeholders’ perceptions about its use. Additionally, we identify barriers to more widespread PC adoption and highlight areas for future research.

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“…Over the past decade, however, referral of patients with ESLD to PC services has slowly increased, with a recent publication documenting a rise in referral rate from 1% in 2006 to 7% in 2012 . Despite this, several inequalities in access to PC services remain.…”

Section: The Role Of Palliative Carementioning

confidence: 99%

“…Despite this, several inequalities in access to PC services remain. Patients with ESLD and low socioeconomic status, Hispanic ethnicity, those who reside in the northeastern part of the United States, and those treated in small and nonteaching hospitals were less likely to receive a PC review . Conversely, patients with HCC or a metastatic cancer were more likely to receive a PC review, likely related to the greater awareness of the benefits of PC for patients with cancer …”

Section: The Role Of Palliative Carementioning

confidence: 99%

Palliative care in end‐stage liver disease: Time to do better?

et al. 2018

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Optimal involvement of palliative care (PC) services in the management of patients with decompensated cirrhosis and end-stage liver disease (ESLD) is limited. This may result from both ignorance and the failure to recognize the spectrum and unpredictability of the underlying liver condition. Palliative care is a branch of medicine that focuses on quality of life (QoL) by optimizing symptom management and providing psychosocial, spiritual, and practical support for both patients and their caregivers. Historically, palliative care has been underutilized for patients with decompensated liver disease. This review provides an evidence-based analysis of the benefits of the integration of palliative care into the management of patients with ESLD. Liver Transplantation 24 961-968 2018 AASLD.

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Palliative care access for hospitalized patients with end‐stage liver disease across the United States

Abstract: From 2006 to 2012 the use of PC in ESLD patients increased substantially; socioeconomic, geographical, and ethnic barriers to accessing PC were observed. (Hepatology 2017;66:1585-1591).

Cited by 81 publications

References 33 publications

Barriers to specialist palliative care in interstitial lung disease: a systematic review

Barriers to specialist palliative care in interstitial lung disease: a systematic review

Current Knowledge, Barriers to Implementation, and Future Directions in Palliative Care for End‐Stage Liver Disease

Palliative care in end‐stage liver disease: Time to do better?

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