Abstract 1278P
Background
Chronic liver disease (CLD) is a major cause of morbidity and mortality. However, they are poorly established metrics to assess the quality of end-of-life (EOL) care in this context. Offering better care to who is dying is an important mission of health professionals, but EOL interventions can be futile, prolong suffering and consume resources better allocated to other needs. We aimed to characterize and compare the EOL of patients with CLD, with and without hepatocellular carcinoma (HCC).
Methods
Retrospective cohort study including all patients who died with CLD between 2012-2021 in charge of Gastroenterology, in a tertiary hospital.
Results
72 patients, 89% male, with a mean age of 64±11 years, 68% Child-Pugh C and 50% with HCC. In the last 6 months of life, patients had a median of 2 (IQR 1-6) hospitalizations, and they were hospitalized a median of 21.5 (IQR 13.25-38.5) days, 15 (IQR 9.25-24.5) in the last month. Only 38% were referred to palliative care (PC), with a median of 5 (IQR 2-15) days between referral and death. 86% had prescribed do-not-resuscitate order, with a median of 3 (IQR 1-9) days between this and death. In 42%, endoscopic procedures were performed in the last hospitalization. In 58% and 17%, it was documented, in the clinical process, discussion of the prognosis with the family and the patient, respectively. There was a significant difference between patients with and without HCC in their referral to PC (53% vs 22%, p-value 0.007) and sharing the prognosis with the patient (31% vs 3%, p-value 0.002).
Conclusions
In this cohort, there was a late referral to PC in general, being lower in the group of patients without HCC. It is imperative to select and apply quality of death metrics in patients with CLD, with and without HCC, aiming to improve care, manage expectations and resources.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.