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Palliative care provision for patients with decompensated advanced chronic liver disease: lessons from the South West
  1. Daniel Maggs1,
  2. Emma Saunsbury2,
  3. Benjamin Masterman3,
  4. Ben Hudson4,
  5. SPRinG Network5
  1. 1Gastroenterology Department, Bristol Royal Infirmary, Bristol, UK
  2. 2Gastroenterology Department, Musgrove Park Hospital, Taunton, UK
  3. 3Gastroenterology Department, Yeovil District Hospital, Yeovil, UK
  4. 4Hepatology Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  5. 5Severn and Peninsula Research in Gastroenterology (SPRinG) Trainee Research Network, Bath, UK
  1. Correspondence to Dr Emma Saunsbury; emma.saunsbury{at}nhs.net

https://doi.org/10.1136/flgastro-2024-102778

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    We were delighted to see specific guidance on palliative care (PC) included in the recently published British Society of Gastroenterology (BSG) best practice guidance on the outpatient management of cirrhosis.1 Decompensated advanced chronic liver disease (dACLD) carries a significant, and seldom addressed, symptom burden.2 3 PC interventions demonstrably improve physical and psychological symptoms in dACLD and do not negatively impact survival.4

    Severn and Peninsula Research in Gastroenterology is a trainee research network. We undertook a retrospective regional service evaluation to assess the quality of PC provided to patients within their last year of life (LYOL) who died of dACLD in the South West of England. Specific objectives were to determine the proportion of patients with documented discussions regarding prognosis and advance care planning (ACP), and/or referral to specialist PC (SPC) services.

    A pre-COVID-19 patient cohort was selected to avoid the confounder of reduced outpatient services during the pandemic. Data regarding adults who died of dACLD between 1 February 2019 and 31 January 2020 were collected from electronic records. Full inclusion and exclusion criteria and statistical analysis details are outlined in online supplemental material. Documented discussions with all members …

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    Footnotes

    • X @esaunsbury, @hudsonbe81

    • Collaborators Severn and Peninsula Research in Gastroenterology (SPRinG) trainee research network collaborators: Katherine Belfield, Oliver Bendall, Frederica Betteridge, Holly Emms, Sarah Godlee, Sarah Gormley, Dilip Gurung, Prakash Katwal, Laurence Knowles, Holly Lyne, Fenella Marley, Giovanna McGinty, Sean Mole, James Nott, Lekshmy Pillai, Keith Pohl, Rhea Randhawa, Ang Sherpa, Alexander Wallace.

    • Contributors DM and ES had a major role and BH had a minor role in conceptualising the regional service evaluation. Individual collaborators collected data, which was collated by ES and DM. BM undertook statistical analysis. ES and DM drafted the manuscript and BH contributed to the revision. All Severn and Peninsula Research in Gastroenterology (SPRinG) trainee research network collaborators (KB, OB, FB, HE, SG, SG, DG, PK, LK, HL, FM, GM, SM, JK, LP, KP, RR, AS and AW) were invited to review and approve the final draft of the manuscript. ES is the guarantor.

    • Funding We are grateful to Guts UK for funding the establishment of a patient and public involvement group, which formed part of this regional service evaluation (grant number: TRN2021_02).

    • Disclaimer The funder did not have any influence on the service evaluation of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.