• Myrick C Shinall, Mohana Karlekar, Sara Martin, Cheryl L Gatto, Sumi Misra, Chan Y Chung, Michael K Porayko, Andrew E Scanga, Natasha J Schneider, E Wesley Ely, Jill M Pulley, Rebecca N Jerome, Mary Lynn Dear, Douglas Conway, Reagan Buie, Dandan Liu, Christopher J Lindsell, and Gordon R Bernard.
• Section of Palliative Care, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee, USA; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: ricky.shinall@vanderbilt.edu.
• J Pain Symptom Manage. 2019 Oct 1; 58 (4): 614-622.e3.

ContextPalliative care interventions have shown promise in improving quality of life and reducing health-care utilization among patients with chronic organ failure.ObjectivesTo evaluate the effect of a palliative care intervention for adults with end-stage liver disease.MethodsA randomized controlled trial of patients with end-stage liver disease admitted to the hepatology service at a tertiary referral center whose attending hepatologist indicated they would not be surprised if the patient died in the following year on a standardized questionnaire was performed. Control group patients received usual care. Intervention group patients received inpatient specialist palliative care consultations and outpatient phone follow-up by a palliative care nurse. The primary outcome was time until first readmission. Secondary outcomes included days alive outside the hospital, referral to hospice care, death, readmissions, patient quality of life, depression, anxiety, and quality of end-of-life care over 6 months.ResultsThe trial stopped early because of difficulties in accruing patients. Of 293 eligible patients, only 63 patients were enrolled, 31 in the intervention group and 32 in the control group. This pace of enrollment was only 25% of what the study had planned, and so it was deemed infeasible to complete. Despite stopping early, intervention group patients had a lower hazard of readmission (hazard ratio: 0.36, 95% confidence interval: 0.16-0.83, P = 0.017) and greater odds of having more days alive outside the hospital than control group patients (odds ratio: 3.97, 95% confidence interval: 1.14-13.84, P = 0.030). No other statistically significant differences were observed.ConclusionLogistical obstacles hindered completion of the trial as originally designed. Nevertheless, a preemptive palliative care intervention resulted in increased time to first readmission and more days alive outside the hospital in the first six months after study entry.Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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