Brief Quality Improvement Report
Benefit of Early Palliative Care Intervention in End-Stage Liver Disease Patients Awaiting Liver Transplantation

https://doi.org/10.1016/j.jpainsymman.2015.07.014Get rights and content
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Abstract

Background

Patients with end-stage liver disease have a predictable and progressive decline in their quality of life because of physical symptoms and psychological distress. Early palliative care intervention (EPCI) correlates with better symptom control and mood. We aimed to improve symptomatology and mood in liver transplant candidates by implementing a longitudinal multidisciplinary EPCI.

Measures

Depression level and symptom burden were assessed with Center for Epidemiological Studies Depression Scale and a modified liver-specific Edmonton Symptom Assessment System scale.

Intervention

All patients referred for liver transplant evaluation between July 2013 and May 2014 were scheduled for EPCI.

Outcomes

After EPCI, 50% of moderate-to-severe symptoms improved (P < 0.05), and 43% of patients showed improvement in clinically significant depressive symptoms (P = 0.003). Notably, patients with more symptoms showed a greater improvement in Center for Epidemiological Studies Depression Scale scores (P = 0.001).

Conclusions/Lessons Learned

Implementation of EPCI improved symptom burden and mood in end-stage liver disease patients awaiting transplant.

Key Words

End-stage liver disease
cirrhosis
liver transplant
early palliative care intervention
ESAS
CES-D

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