Palliative Care and Hospice Referrals in Patients with Decompensated Cirrhosis: What Factors Are Important?

John H. Holden, Hani Shamseddeen, Amy W. Johnson, Benjamin Byriel, Kavitha Subramoney, Yao Wen Cheng, Akira Saito, Marwan Ghabril, Naga Chalasani, Greg A. Sachs, Eric Orman

Research output: Contribution to journalArticle


Background: Palliative care (PC) and hospice care are underutilized for patients with end-stage liver disease, but factors associated with these patterns of utilization are not well understood. Objective: We examined patient-level factors associated with both PC and hospice referrals in patients with decompensated cirrhosis (DC). Design: Retrospective cohort study. Setting/Subjects: Patients with DC hospitalized at a single tertiary center and followed for one year. Measurements: We assessed PC and hospice referrals during follow-up and examined patient-level factors associated with the receipt of PC and/or hospice, as well as associated clinical outcomes. We also examined late referrals (within one week of death). Results: Of 397 patients, 61 (15.4%) were referred to PC, 71 (17.9%) were referred to hospice, and 99 (24.9%) were referred to PC and/or hospice. Two hundred patients (50.4%) died during the one-year follow-up. In multivariable logistic regression, referral to PC was associated with increased comorbidity burden, ascites, increased MELD (Model for End-Stage Liver Disease)-Na score, lack of listing for liver transplant, and unmarried status. Hospice referral was associated with increased comorbidities, portal vein thrombosis, and hepatocellular carcinoma. PC referrals were late in 68.5% of cases, and hospice referrals were late in 62.7%. Late PC referrals were associated with younger age and married status. Late hospice referrals were associated with younger age and recent alcohol use. Conclusions: PC and hospice is underutilized in patients with DC, and most referrals are late. Patient-level factors associated with these referrals differ between PC and hospice.

Original languageEnglish (US)
Pages (from-to)1066-1075
Number of pages10
JournalJournal of palliative medicine
Issue number8
StatePublished - Aug 1 2020


  • hospice
  • liver cirrhosis
  • palliative care

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

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