The incompatibility of healthcare services and end-of-life needs in advanced liver disease: A qualitative interview study of patients and bereaved carers

Benjamin Hudson*, Victoria Hunt, Andrea Waylen, Catherine Anne McCune, Julia Verne, Karen Forbes

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    32 Citations (Scopus)

    Abstract

    Background: Liver disease represents the third commonest cause of death in adults of working age and is associated with an extensive illness burden towards the end of life. Despite this, patients rarely receive palliative care and are unlikely to be involved in advance care planning discussions. Evidence addressing how existing services meet end-of-life needs, and exploring attitudes of patients and carers towards palliative care, is lacking. Aim: To explore the needs of patients and carers with liver disease towards the end of life, evaluate how existing services meet need, and examine patient and carer attitudes towards palliative care. Design: Qualitative study – semi-structured interviews analysed using thematic analysis. Settings/participants: A total of 17 participants (12 patients, 5 bereaved carers) recruited from University Hospitals Bristol. Results: Participants described escalating physical, psychological and social needs as liver disease progressed, including disabling symptoms, emotional distress and uncertainty, addiction, financial hardship and social isolation. End-of-life needs were incompatible with the healthcare services available to address them; these were heavily centred in secondary care, focussed on disease modification at the expense of symptom control and provided limited support after curative options were exhausted. Attitudes towards palliative care were mixed, however, participants valued opportunities to express future care preferences (particularly relating to avoidance of hospital admission towards the end of life) and an increased focus on symptomatic and logistical aspects of care. Conclusion: The needs of patients with liver disease and their carers are frequently incompatible with the healthcare services available to them towards the end of life. Novel strategies, which recognise the life-limiting nature of liver disease explicitly and improve coordination with community services, are required if end-of-life care is to improve.

    Original languageEnglish
    Pages (from-to)908-918
    Number of pages11
    JournalPalliative Medicine
    Volume32
    Issue number5
    DOIs
    Publication statusPublished - 1 May 2018

    Bibliographical note

    Funding Information:
    The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This study was funded with support from the David Telling Charitable Trust.

    Publisher Copyright:
    © 2018, © The Author(s) 2018.

    Keywords

    • Caregivers
    • cirrhosis
    • end of life
    • health services
    • liver disease
    • palliative care
    • qualitative research
    • supportive care

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