Introduction Liver disease is the fifth most common cause of death in the UK.1Patients with chronic liver disease (CLD) and its complications present frequently to hospital; when their disease reaches end-stage, their supportive and palliative care needs can be high2. In this study we describe the last year of life in patients with CLD, aiming to identify opportunities for earlier concurrent palliative care involvement in the future.
Method We performed a comprehensive retrospective casenote analysis of patients who died of CLD (or complications) in a teaching hospital over a period of 12 months. Caldicott approval was obtained.
Results Reasons for admission in the 77 cases identified were varied, but could all be attributed to decompensation of CLD. Alcohol was the causative factor in 65 (84.4%) cases. 69 patients (89.6%) had DNACPR orders in place when they died. Patients died both on the ward (47%–61% of patients) and in level 2/3 settings (29%–37.7% of patients); 1 died in endoscopy. A minority (19.5%) met the specialist palliative care team. Of these 15 patients, 1 was referred to palliative care by their GP, and the remaining 14 were referred by the inpatient medical team. These 14 patients met the hospital palliative care team an average of 17.6 days before death. Many patients had active interventions and investigations within 24 hours of death, including 68.8% of patients who had bloods taken.
Conclusion We were able to perform a detailed examination of the hospital admissions of this cohort of patients during the last year of life. We identified alcohol as a contributing factor in 84.4% of cases, however this did not appear to prejudice clinicians from admitting patients to level 2/3 care. It appears that DNACPR is considered appropriately, however patients are still having investigations and non-symptomatic medications even after death is recognised as imminent. More work is needed to identify whether earlier, consistent palliative care involvement could be helpful to these patients.
. British Association for the Study of the Liver and British Society of Gastroenterology. A time to act: improving liver health and outcomes in liver disease. The National Plan for Liver Services UK, 2009.
. Hansen L, Sasaki A, Zucker B. End-stage liver disease: challenges and practice implications. Nurs Clin North Am2010; 45: 411–26.k
Disclosure of Interest None Declared
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