An evaluation examining the effect of a palliative care service referral on patients with malignant and non-malignant liver disease. A start to improving joint working with hepatology

Introduction Mortality rate from chronic liver disease (CLD) in the UK has risen by around 400% since 19701, as has the financial burden, with the cost to the NHS being £2.1 billiona year2. On average, patients with CLD have >5 admissions to hospital in the year prior to their death, and over 80% die in hospital2.

The aim was to identify the prevalence of symptom care needs, demographics and outcomes of the CLD population accessing hospice services in one area of South East England.

Methods A patient record review of referrals to three hospice inpatient and community palliative care services between 1/11/2018 and 31/10/2020. Demographic, Outcome Assessment and Complexity Collaborative (OACC), reported symptoms from integrated palliative care outcome scale (iPOS) and hospital admission data were collected.

Results 121 patients were identified, only 85 had analysable records:

87% of patients had died.

81% were male.

85% were of white background.

The mean age was 74.

Non-malignant CLD vs malignant: 38% vs 61%.

Most common reported symptoms: pain, breathlessness, gastrointestinal disturbances, weakness and psychiatric issues.

Mean acute admissions prior to death: 2.4 (range 0–9).

Mean time under service: 72 days (range 0–636).

70% of patients either died at home/hospice, and 43% died in their PPD.

Conclusions:

Our demographics were in keeping with those of the British Liver Trust statistics3. Compared to these statistics, our population were less likely to die in the acute sector and had less admissions to it prior to their deaths. Our data suggests that we are having an impact with advance care planning and admission avoidance, however it is clear that patients are not being referred to our services early enough. We plan to compare our data with the overall data of the region and continue to foster strong collaborative links with our local

hepatology service.