For a study, researchers sought to determine the link between palliative care (PC), patient-reported variables (quality of life and functional status), and outcomes. They conducted a prospective cohort analysis of cirrhotic patients hospitalized between 2014 and 2019. They documented the specifics of the PC consultation, the quality of life (chronic liver disease questionnaire), and the functional state (functional status questionnaire). In addition, patients were tracked for 90 days to determine readmissions, expenses, and death.
PC was seen by 74 of 679 patients, typically late in the stay (median hospital day 8; IQR 4–16). PC patients had a higher Charlson comorbidity index (mean 6.8 vs. 5.9), MELD (mean 25 vs. 20), and a prior 30-day stay (47% vs. 35% ). PC patients had greater impairments in intermediate activities of daily living (83% vs. 72%), social activity (72% vs. 59%), quality of interactions (49% vs. 36%), abdominal symptoms (mean score 3.1 vs. 3.6), activity (mean 3.3 vs. 3.6), and overall quality of life compared to those who did not see PC (mean 3.6 vs. 3.8). PC was linked to fewer transfusions, upper endoscopies, and higher completion rates of advance directives. PC was not linked with intensive care, 30-day readmissions, 90-day expenses, or death after multivariable correction. In people with significant liver disease and functional impairment, PC appeared seldom and late. PC may be linked to lower usage and better fulfillment of advanced directives. Randomized studies are required to assess PC in this group.
Reference:www.jpsmjournal.com/article/S0885-3924(22)00107-5/fulltext
