Physicians' perspectives on palliative care for patients with end-stage liver disease : a national survey study

Article

UFERE, Nneka N. | DONLAN, John | WALDMAN, Lauren | PATEL, Arpan | DIENSTAG, Jules L. | FRIEDMAN, Lawrence S. | COREY, Kathleen E. | HASHEMI, Nikroo | CAROLAN, Peter | MULLEN, Alan C. | THIIM, Michael | BHAN, Irun | NIPP, Ryan | GREER, Joseph | TEMEL, Jennifer | CHUNG, Raymond T. | EL-JAWAHRI, Areej

BACKGROUND: Specialty palliative care (PC) is underutilized for patients with end-stage liver disease (ESLD). We sought to examine hepatologists' and gastroenterologists' attitudes about PC for patients with ESLD. METHODS: We conducted a cross-sectional survey of hepatologists' and gastroenterologists' who provide care to patients with ESLD recruited from the American Association for the Study of Liver Diseases membership directory. Using a questionnaire adapted from prior studies, we examined physicians' attitudes about PC and whether these attitudes varied based on patients' candidacy for liver transplantation. We identified predictors of physicians' attitudes about PC using linear regression. RESULTS: Approximately one-third of eligible physicians (396/1236, 32%) completed the survey. Most (95%) believed that centers providing care to patients with ESLD should have PC services, and 86% trusted PC clinicians to care for their patients. Only a minority reported collaborating frequently with inpatient (32%) or outpatient (11%) PC services. Most believed that when patients hear the term PC, they feel scared (94%) and anxious (87%). Most (83%) believed that patients would think nothing more could be done for their underlying disease if a PC referral was suggested. Physicians who believed that ESLD is a terminal condition (B=1.09, p = 0.006) reported more positive attitudes about PC. Conversely, physicians with negative perceptions of PC for transplant candidates (B = -0.22, SE = 0.05, p < 0.001) reported more negative attitudes toward PC. CONCLUSION: Although most hepatologists' and gastroenterologists' believe that patients with ESLD should have access to PC, they reported rarely collaborating with PC and had substantial concerns about patients' perceptions of PC. Interventions are needed to overcome misperceptions of PC and promote collaboration with PC clinicians for patients with ESLD.

http://dx.doi.org/10.1002/lt.25469

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