Early Experience of a Dedicated Outpatient Palliative Hepatology Clinic: Referral Patterns, Patient Characteristics, and Outcomes.

Abstract

Background and AimsDedicated outpatient palliative hepatology clinics remain uncommon despite the substantial symptom burden of advanced liver disease. We describe the early experience of a newly established outpatient palliative hepatology clinic.MethodsWe retrospectively reviewed patients scheduled for an initial consultation during the first months of clinic operation. Demographic and clinical characteristics, referral indications and sources, symptoms, advance care planning, follow-up, and outcomes were collected from the electronic medical record and summarized using descriptive statistics.ResultsAmong 26 scheduled patients, median age was 60 years (IQR, 41-71), median MELD 3.0 was 21 (IQR, 14-30), and 23 (89%) had prior cirrhosis-related hospitalization(s). Common referral indications included supportive care needs (81%), goals-of-care discussions (65%), and symptom management (39%). Referrals primarily came from hepatology/gastroenterology (54%) and inpatient palliative care (31%). Eighteen patients (69%) attended; 4 (15%) died before their scheduled appointment. Among those evaluated, pain and nausea were most common (56% each). Goals-of-care discussions occurred in 67%, advance directives were discussed in 72%, and surrogate decision makers in 83%. During a median follow-up of 192 days, 61% returned for follow-up and 33% died. Median time from the initial clinic visit to death was 51 days.ConclusionsPatients referred to our palliative hepatology clinic had advanced disease and substantial supportive care needs. High rates of goals-of-care and advance care planning among those evaluated highlight the potential value of dedicated palliative hepatology clinics.