Two models of palliative care yield similar outcomes in end-stage liver disease

Palliative care delivered by hepatologists yields similar improvements in quality of life (QoL) of patients with end-stage liver disease (ESLD) and is associated with greater patient satisfaction compared with palliative care delivered by specialists, according to a study.

The study included 935 adult patients (mean age 63 years, 29 percent female, 79 percent White) treated for ESLD at 19 medical centres across the US. These patients had either decompensated cirrhosis or hepatocellular cancer who had a life expectancy of ≥6 months, had not received liver transplantation, or had not received palliative care in the prior 3 months.

The patients were randomly assigned to undergo a palliative care intervention delivered either by palliative care–trained hepatologists (hepatologist group; 11 centres) or palliative care specialists (consultative group; 8 centres). The intervention consisted of four palliative care visits over 3 months.

Change in QoL at 3 months was the primary outcome, assessed using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) total score (higher scores indicating better QoL). Secondary outcomes included change in symptom burden, distress, depression, satisfaction, and mortality.

At 3 months, QoL improved in both the hepatologist (mean change, 8.01 points, 95 percent confidence interval [CI], 5.38–10.65; p<0.001) and consultative (mean change, 7.02 points, 95 percent CI, 4.34–9.71; p<0.001). Hepatologist-delivered palliative care showed noninferiority (adjusted mean difference, 0.98, 95 percent CI, −2.86 to 4.83; p=0.01) but not superiority to specialist-delivered palliative care.

Both the hepatologist and consultative groups had similar improvements in symptom burden (adjusted mean difference, −7.52 vs −5.31) and depression (adjusted mean difference, −1.18 vs −0.90) improved in both groups.

However, patient satisfaction was better in the hepatologist group than the consultative group (adjusted mean difference, 3.37 vs 0.91; p=0.002).

Mortality at 3 months did not significantly differ between the two groups.