Serene image of stylized liver with blooming flowers representing palliative care.

Navigating End-Stage Liver Disease: Why Palliative Care Matters

Theo Raines in Health & Wellness December 2025 • 4 min read.

"Understanding the Underutilization of Palliative Care in Decompensated Liver Disease and Its Impact on Patient Outcomes"

Liver cirrhosis, a progressive condition leading to decompensation, often results in repeated hospital admissions for patients ineligible for transplantation. Managing these patients requires a comprehensive approach, including palliative care services, yet these services are often underutilized.

A recent retrospective study examined the care of adult patients with known cirrhosis who were admitted with decompensated cirrhosis to Queen Elizabeth II Health Sciences Centre in Halifax, NS, between May 2015 and May 2017. The study aimed to characterize this patient population, detailing their healthcare utilization, with a particular focus on palliative care services.

The research meticulously collected data on various aspects, including the length of hospital stay, the underlying cause of liver disease, complications, co-morbidities, goals of care discussions, transplant candidacy, and MELD-Na scores. It also looked at consultations, procedures, diagnostic imaging, palliative care usage, ICU admissions, and the need for intubation or dialysis.

Key Findings: Understanding the Gaps in End-of-Life Care

Serene image of stylized liver with blooming flowers representing palliative care.

The study, which analyzed 28 patients with known liver cirrhosis who died during the study period, revealed significant insights into the care these patients received. The average age of patients was 44 to 79 years (mean 59), with 61% being male. The average length of stay was 22 days, and the mean MELD-Na score was 26, indicating severe liver disease. A significant majority (93%) had at least one previous decompensation documented before their admission, highlighting the chronic and progressive nature of their condition.

The utilization of various medical interventions was notable:

86% received antibiotics
40% underwent at least one endoscopy
79% had at least one specialist consultation
71% had at least three diagnostic images
25% required ICU admission
14% needed new dialysis

Despite the intensity of medical interventions, a concerning number of patients did not receive adequate consideration for palliative care or have their wishes documented. Most patients (68%) did not have eligibility for liver transplantation detailed anywhere in their chart during hospitalization, and this was not documented previously for 75% of patients. Moreover, while patients had a mean of 3.2 emergency department visits and 2.3 clinic visits in the 6 months before admission, only 46% saw a hepatologist during that time. Furthermore, only 14% received palliative care before death, and a mere 7% had documented outpatient goals of care discussions within 2 years before death.

The Imperative for Improved Palliative Care Integration

This study underscores a critical need to improve the integration of palliative care for patients with decompensated liver disease. The findings reveal that while these patients often have high MELD-Na scores and prolonged admissions, indicating significant disease burden, very few have documented goals of care discussions or assessments of their eligibility for liver transplantation.

The underutilization of palliative care and the lack of documented care goals highlight a systemic gap in addressing the holistic needs of these patients. Early integration of palliative care can facilitate crucial conversations about patient preferences, manage symptoms, and improve the overall quality of life during the final stages of the disease.

Healthcare providers should prioritize proactive discussions about palliative care options, ensuring that patients' wishes are understood and respected. Furthermore, regular assessments of transplant eligibility and thorough documentation are essential to guide appropriate care decisions. By addressing these gaps, healthcare systems can better support patients with decompensated liver disease, providing them with compassionate and comprehensive care that aligns with their values and preferences.

About this Article -

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Everything You Need To Know

What is the significance of MELD-Na scores in the context of end-stage liver disease?

MELD-Na scores are crucial because they indicate the severity of liver disease. A high MELD-Na score, such as the mean of 26 observed in the study, suggests severe liver disease and is associated with increased mortality risk. These scores help in prioritizing patients for liver transplantation and assessing the urgency of their medical needs. However, the study revealed that despite high MELD-Na scores among patients with decompensated liver disease, discussions about liver transplantation eligibility and goals of care were often lacking.

Why is palliative care underutilized in patients with decompensated liver cirrhosis, and what are the implications of this underutilization?

Palliative care is underutilized due to several factors, including a lack of awareness among healthcare providers about its benefits for patients with liver cirrhosis, challenges in prognostication, and a focus on disease-modifying treatments rather than quality-of-life interventions. The implications of this underutilization are significant: patients may experience unnecessary suffering, prolonged hospital stays, and a failure to address their holistic needs, including physical, emotional, and spiritual well-being. Integrating palliative care earlier could improve patient comfort, reduce hospital readmissions, and align treatment with patient values and preferences.

What specific interventions were commonly used in the care of patients with decompensated liver disease, and how does this compare to the utilization of palliative care?

The study highlighted that patients with decompensated liver disease frequently received medical interventions such as antibiotics (86%), endoscopies (40%), specialist consultations (79%), and diagnostic imaging (71%). Additionally, a notable percentage required ICU admission (25%) and new dialysis (14%). In stark contrast, only 14% received palliative care before death. This discrepancy underscores a significant gap in care, suggesting that while aggressive medical treatments are common, holistic, comfort-focused care is often overlooked, potentially leading to a lower quality of life for patients in their final stages.

How does the lack of documented goals of care discussions impact patients with decompensated liver disease, and what steps can be taken to improve this?

The absence of documented goals of care discussions, as highlighted by the study's finding that only 7% of patients had these discussions documented, means that patients' wishes and preferences regarding their end-of-life care may not be adequately considered or respected. This can lead to unwanted or ineffective treatments, increased distress for patients and families, and a sense of loss of control over their healthcare decisions. To improve this, healthcare providers should proactively initiate goals of care conversations, document these discussions thoroughly, and ensure that patients' values and preferences guide treatment decisions. Standardized protocols and training programs can facilitate these discussions and promote a patient-centered approach to care.

What are the key barriers to assessing eligibility for liver transplantation in patients with decompensated liver disease, and how can these barriers be overcome?

Several barriers contribute to the lack of documented liver transplantation eligibility assessments. These include time constraints, a focus on managing acute complications, uncertainty about prognosis, and a lack of standardized assessment protocols. Overcoming these barriers requires a multi-faceted approach: Implementing systematic screening processes, providing education and training to healthcare providers on transplant eligibility criteria, and fostering interdisciplinary collaboration between hepatologists, palliative care specialists, and transplant teams. By addressing these challenges, healthcare systems can ensure that all eligible patients are considered for transplantation and that those who are not eligible receive appropriate palliative care to manage their symptoms and improve their quality of life.