Health Care Proxy Research Articles

The Impact of Functionality and Psychological Outcome on Social Engagement 3-months after Intracerebral Hemorrhage

BackgroundAlthough it is well-known that intracerebral hemorrhage (ICH) is associated with physical and psychological morbidity, there is scant data on factors influencing social engagement after ICH. Understanding the relationship between functionality, psychological outcome and social engagement post-bleed may facilitate identification of patients at high risk for social isolation after ICH. MethodsPatients ≥18-years-old with non-traumatic ICH from January 2015-March 2023 were identified from the Neurological Emergencies Outcomes at NYU (NEON) registry. Data on discharge functionality were collected from the medical record. 3-months post-bleed, patients/their legally-authorized representatives (LARs) were contacted to complete Neuro-QoL social engagement, anxiety, depression, and sleep inventories. Patients were stratified by ability to participate in social roles and activities (good=T-score>50, poor=T-score≤50) and satisfaction with social roles and activities (high=T-score>50 and low=T-score≤50). Univariate comparisons were performed to evaluate the relationship between post-bleed social engagement and both functionality and psychological outcome using Pearson’s chi-square, Fisher’s Exact test, and Mann-Whitney U tests. Multivariate logistic regression was subsequently performed using variables that were significant on univariate analysis (p<0.05). ResultsThe social engagement inventories were completed for 55 patients with ICH; 29 (53 %) by the patient alone, 14 (25 %) by a LAR alone, and 12 (22 %) by both patient and LAR. 15 patients (27 %) had good ability to participate in social roles and activities and 10 patients (18 %) had high satisfaction with social roles and activities. Social engagement was associated with both functionality and psychological outcome on univariate analysis, but on multivariate analysis, it was only related to functionality; post-bleed ability to participate in social roles and activities was associated with discharge home, discharge GCS score, discharge mRS score, and discharge NIHSS score (p<0.05) and post-bleed satisfaction with social roles and activities was related to discharge mRS score and discharge NIHSS score (p<0.05). ConclusionIn patients with nontraumatic ICH, social engagement post-bleed was related to discharge functionality, even when controlling for depression, anxiety, and sleep disturbance.

Ethical Accompaniment and End-of-Life Care

Abstract A theology of accompaniment offers insights on how to journey with and be present to those who suffer from terminal illness. In order to sustain acts of accompaniment, the companion must cultivate specific virtues through prayer and the practices of the Christian community. This ethic of accompaniment is based on a Thomistic conceptualization of the virtues of charity and fortitude. These virtues enable the companion to engage in four types of practices with and on behalf of the dying patient. Ethical accompaniment offers the following contributions to end-of-life care, the companion can function as a healthcare proxy, offers a viable alternative to physician-assisted suicide, and overcomes the loss of meaning associated with death through the Christian narrative.

Collaborative advance care planning in palliative care: a randomised controlled trial

ObjectiveAn effective tool for establishing concordant end-of-life (EOL) care in patients with cancer is advance care planning (ACP). However, various barriers, including psychological obstacles, hamper the access to ACP. Therefore,...

The Italian law 219/2017: informed consent and advance directives. When the patient-doctor communication time is law, but it is forgotten

The Italian law 217/2019 on "Informed consent and advance directives" is an important step forward in the redefinition of patient-doctor relationships. The law points out the principles of the decisional autonomy and freedom of the patient to choose the treatment options. However, it is underestimated and largely unapplied by the Italian cardiologists. The main elements of patient-doctor communication are present in the law. The most important is the time devoted to the patient-doctor relationship, necessary to ease the disease awareness. This time is clearly emphasized in the law, but the healthcare institutions did not arrange for the appropriate organizational procedures. Through the advance directives (ADs) the patients may express their own wishes about healthcare treatments, as well as their consent or refusal regarding the diagnostic or therapeutical doctors' suggestions, allowing their respect in case they become incompetent. This right is supported by the patients' designation of a healthcare proxy, who can interact for them with the healthcare team. However, after 6 years since the law enactment, only 0.4% of the Italian citizens signed ADs, due to insufficient information and organization by the healthcare authorities. In the Law, the advance care planning is closely related to ADs. In this process, the adults can understand and share their personal values, life goals and preferences, in order to define the potential future medical care and to discuss all the issues with family and physicians. These processes can be integrated in a broader shared decision-making, a strong tool of the patient-doctor alliance.

Collaborative Teamwork on Advanced Care Planning and Health Care Proxy

Collaborative Teamwork on Advanced Care Planning and Health Care Proxy

Frequency and barriers to the patient advanced directive and lasting power of attorney: findings from a prospective observation study in palliative care services

The advance directive and lasting power of attorney are instruments to strengthen patients' autonomy. Ahospital-based palliative care consultation service can advise patients and family members about these instruments. This study investigates the need for such consultation among patients with life-limiting illness. This prospective observational study on intensive and non-intensive care units includes patients with arequest for palliative care consultation. Patient-related factors were evaluated for their possible association with the presence or absence of advance directives or power of attorney. In addition, focus group interviews with members of the palliative care consultation team were carried out to identify barriers which prevent patients from drawing up such documents. Atotal of 241 oncological and 53non-oncological patients were included with amedian age of 67years; 69(23%) patients were treated in the intensive care unit (ICU). Overall, 98(33%) patients had advance directives, and 133 (45%) had determined alegal health care proxy in advance. Atotal of 52patients died in hospital (17.7%). Only age and relationship status were associated with directives. In interviews, the following barriers were identified: information deficit, concern regarding discontinuation of treatment, loss of autonomy and wish to avoid aburden for the family. The majority in this severely ill patient population lack advance directives. In order to remove barriers, more effective information and counseling is required about such directives. In particular, guidance should include potential clinical situations in which such directives are potentially beneficial.

Aligning goals with care: Advance directives in older adults with implantable cardioverter-defibrillators.

Patients ≥80 with implantable cardioverter-defibrillators (ICDs) have high rates of hospitalization and mortality, yet few have documented advance directives. We sought to determine the prevalence of advance directives in adults ≥80 years with ICDs, focusing on those with frailty and cognitive impairment. Prospective cohort study (July 2016-May 2019) in an electrophysiology clinic. Presence of advance directives (health care proxies [HCP] and living wills [LW], or medical orders for life-sustaining treatment [MOLST]) was determined by medical record review. Frailty and cognitive impairment were screened using 4-m gait speed and Mini-Cog. 77 Veterans were evaluated. Mean age 84 years, 100% male, 70% frail. Overall, 52 (68%) had an HCP and 37 (48%) had a LW/MOLST. Of 67 with cognitive testing, 36% were impaired. HCP documentation was similar among frail and non-frail (69%vs. 65%). LW/MOLST was more prevalent among frail versus non-frail (52%vs. 39%). There was no difference in HCP documentation by cognitive status (67%). A LW/MOLST was more frequent for cognitively impaired versus non-impaired (50%vs. 42%). Among 19 Veterans who were frail and cognitively impaired, 14 (74%) had an HCP and 11 (58%) had a LW/MOLST. Most Veterans had a documented advance directive, but a significant minority did not. Simple frailty and cognitive screening tools can rapidly identify patients for whom discussion of advance directives is especially important.

Stability of End-of-Life Care Wishes and Gender-Specific Characteristics of Outpatients with Advanced Cancer under Palliative Therapy: A Prospective Observational Study

Introduction: Early integration of palliative care and advance care planning (ACP) play an increasingly important role in the treatment of patients with advanced cancer. Advance directives (ADs) and patients’ preferences regarding end-of-life (EoL) care are important aspects of ACP. In the outpatient setting, the prevalence of those documents and EoL care wishes is not well investigated, and changes in the longitudinal course are poorly understood. Methods: From June 2020 to August 2022, 67 outpatients with advanced solid tumors undergoing palliative cancer therapy were interviewed on the topic of ACP in a longitudinal course. From this database, the prevalence of ADs, healthcare proxy, EoL care wishes, and the need for counseling regarding these issues were collected. In addition, EoL care wishes were examined for their stability. Results: Fifty-one patients (76.1%) reported having ADs, and 41 patients (61.2%) reported having a healthcare proxy. Nineteen patients (37.3%) with ADs and 11 patients (68.7%) without ADs indicated a wish for counseling. Reported EoL care wishes remained stable over a period of approximately 6 months. Nevertheless, intraindividual changes occurred over time within the different EoL care preferences. The desire for resuscitation and dialysis were significantly higher in men than in women (resuscitation: 15 of 21 men [71.4%] versus 9 of 22 women [40.9%], odds ratio [OR] 3.611, 95% confidence interval [CI], 1.01–12.89, p = 0.048; dialysis: 16 of the 23 men [69.6%] versus 9 of the 25 women [36.0%], OR: 4.063, 95% CI: 1.22–13.58, p = 0.023). Conclusion: Our results show a reasonably high percentage of ADs and healthcare proxies in our study cohort. The observed stability of EoL requests encourages the implementation of structured queries for ADs and healthcare proxy for outpatients undergoing palliative treatment. Our data suggest that gender-specific characteristics should be further investigated in this context.

Factors associated with loss to follow-up in patients with advanced age-related macular degeneration: A telehealth recall initiative.

Patients with advanced age-related macular degeneration (AMD) frequently experience loss to follow-up (LTFU), heightening the risk of vision loss from treatment delays. This study aimed to identify factors contributing to LTFU in patients with advanced AMD and assess the effectiveness of telephone-based outreach in reconnecting them with eye care. A custom reporting tool identified patients with advanced AMD who had not returned for eye care between 31 October 2021 and 1 November 2022. Potentially LTFU patients were enrolled in a telephone outreach programme conducted by a telehealth extender to encourage their return for care. Linear regression analysis identified factors associated with being LTFU and likelihood of accepting care post-outreach. Out of 1269 patients with advanced AMD, 105 (8.3%) did not return for recommended eye care. Patients LTFU were generally older (89.2 ± 8.9 years vs. 87.2 ± 8.5 years, p = 0.02) and lived farther from the clinic (25 ± 43 miles vs. 17 ± 30 miles, p = 0.009). They also had a higher rate of advanced dry AMD (26.7% vs. 18.5%, p = 0.04) and experienced worse vision in both their better-seeing (0.683 logMAR vs. 0.566 logMAR, p = 0.03) and worse-seeing (1.388 logMAR vs. 1.235 logMAR, p = 0.04) eyes. Outreach by a telehealth extender reached 62 patients (59%), 43 through family members or healthcare proxies. Half of the cases where a proxy was contacted revealed that the patient in question had died. Among those contacted directly, one third expressed willingness to resume eye care (20 patients), with 11 scheduling appointments (55%). Despite only two patients returning for in-person eye care through the intervention, the LTFU rate halved to 4.4% by accounting for those patients who no longer needed eye care at the practice. There is a substantial risk that older patients with advanced AMD will become LTFU. Targeted telephone outreach can provide a pathway for vulnerable patients to return to care.

‘When I tried to explain, they shouted back at me!’: exploring how community pharmacists navigate tensions implementing antimicrobial stewardship in Vietnam

ABSTRACT Antimicrobial resistance is a major global and national health challenge, accelerated by ‘irrational’ antibiotic use. In response, Vietnam has been implementing a public health plan of antimicrobial stewardship since 2013 to reduce antibiotic sales in community pharmacies, although it has had limited effect. Given that private pharmacies are increasingly the entry point to access healthcare, reflective of the inhibited accessibility of primary healthcare, understanding how the positioning of community pharmacists shapes the delivery of antimicrobial stewardship plans warrant further investigation. This qualitative analysis draws on data from 24 in-depth interviews with licensed community pharmacists in Vietnam. Interviewees described being constrained in rationing the sale of antibiotics by tensions within their professional role, in which the delivery of antimicrobial stewardship within their public health commitments rubs up against commercial and social obligations to their livelihoods and communities respectively. The concept of ‘resistance’ provides insight into what obstructs the integration of national antimicrobial stewardship guidance and policy, hindering the transformation of local practices concerning antibiotic sales at the community level. Findings reveal opportunities to recast community pharmacists as ‘productive anchors’ who can facilitate the appropriate use of antibiotics and strengthen links to primary care within the local context. Structural changes are needed, however, so that people do not use antibiotics as a proxy for health care. Improving the accessibility of primary healthcare would also curtail the reliance on community pharmacists’ to dispense antibiotics as a local mechanism of financial protection and social care within community.

Abstract WP95: The Effectiveness of Remote Informed Consent for Clinical Intervention in the Setting of Acute Ischemic Stroke

Background: Informed consent is an essential part of current medical practice which protects the patient’s right to make an informed decision with sufficient understanding of the risks and the benefits of any medical intervention. Because of the need to provide care quickly, consent is often obtained remotely in acute ischemic stroke. Currently, to our knowledge, no study has provided a direct measurement of effectiveness of remote consent compared to in-person consent. In this study, we surveyed those providing consent for thrombolysis and thrombectomy for satisfaction with the consent process. We also compared in person and remote consent for effectiveness in understanding of the intervention. Methods: We conducted post-consent surveys of the person consenting to either thrombolysis or thrombectomy (patient or their legally authorized representative). Surveys assessed satisfaction with the consent process including if the explanation of the procedure was clear and if they had comfortable level of understanding. Survey also included self- and objective assessments of the information provided. Patients who received thrombolysis via wake-up protocol, or as part of another research study, were excluded. Results: A total of 86 surveys assessing 61 remote and 25 in-person consents were analyzed. The in person consents were 56% thrombectomy, while remote consents were 97% thrombectomy. Both in-person and remote groups had high satisfaction rate (9.72/10 vs 9.44/10, P = 0.301) and high self-assessment of understanding (2.56/3 vs 2.74/3, P = 0.11). Objective assessment testing consenter’s knowledge of the procedure showed slightly lower performance for in-person consent, although this was statistically not significant (91% vs 93%, P= 0.17). Further analysis excluding self-consents showed no difference in the two groups (92% vs 94%, P = 0.77). Conclusion: Our observational study showed that patient and legal authorized representatives had a similarly satisfactory experience and understanding when consenting to thrombolysis/thrombectomy when consented in person compared to remote consent.

Cognitive abilities and engagement in advance care planning among older adults: Results of a Swiss populational study.

Individuals often wait until the last moment to plan their end-of-life (EOL) care. Yet, decision-making capacity decreases with age, which could compromise engagement in and the effectiveness of advance care planning (ACP). Little is known about the association between cognitive abilities and the steps involved in the multifaceted process of ACP in older adults. The present study aims to better understand the association of global cognitive competence with engagement in ACP in a nationally representative sample of older adults in Switzerland. Global cognitive competence was measured via verbal fluency, immediate and delayed memory, basic calculation skills, and temporal orientation. Engagement in ACP included approving advance directives, having discussed EOL preferences, having a living will, and having a health care proxy. We analyzed data of 1,936 respondents aged 55+ from a paper-and-pencil questionnaire that was administered as part of Wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe in Switzerland using logistic regression models. Respondents with reduced global cognitive competence are less likely to have discussed their EOL preferences with others and to have a living will. Our results also indicate an interaction between age and cognition with respect to having a living will. Individuals with lower global cognitive competence in the oldest age group-adults aged 75 and older-are less likely to have a living will. Our findings highlight that low global cognitive competence can be seen as a barrier to engagement in ACP, particularly among adults 75 years and older. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Improving the Accuracy of Code Status Documentation in Home Care.

Advance care planning discussions require specialized skills to elicit goals and preferences from patients contending with life-limiting illness. Documentation forms which include Health Care Proxies, Medical Orders for Life Sustaining Treatments, or Physician Orders for Life Sustaining Treatments are meant to accompany patients through every transition of care. However, they are often forgotten between the hospital and the home setting. Home care clinicians have the obligation to ensure all providers involved in the patient's care are made aware of their code status and goals of care. Consequently, home care clinicians need education about advance care planning to support patients in achieving their care goals as they transition from hospital to home. This quality improvement project implemented three consecutive interventions including reminding clinicians to review code status orders, applying short educational interventions at daily nursing huddles via email, and finally, administering primary palliative education classes for home care clinicians. The purpose was to guide home care nurses in reviewing and reaffirming code status orders and advance care documentation at the initiation of the home care episode and to improve the consistency and accuracy of code status documentation at the transition of care. After implementing the interventions to improve code status documentation, compliance improved from 8% to 100% in a 10-month period.

Dialysis decision-making process by Chinese American patients at an urban, academic medical center: a retrospective chart review

BackgroundClinical practice guidelines emphasize shared decision-making for kidney replacement treatment, yet little is known about the influence of cultural differences on that process. We undertook a retrospective chart review to explore the process and timing of dialysis decision making and initiation in Chinese American patients to provide quality kidney care for this population.DesignParticipants received outpatient care at Tufts Medical Center and dialysis at Dialysis Clinic, Inc. Boston or Somerville, MA from 2001–2021. Clinic chart review sourced demographic, clinical, and end-of-life care information from 180 participants (82 Chinese American, 98 other) from stage 4 chronic kidney disease (CKD) and dialysis initiation.ResultsChinese American participants were older (mean 70 vs. 59, p < 0.0001), less likely to speak English (12% vs. 87%, p < 0.0001), and used interpreter services more (80% vs. 11%, p < 0.0001). Chinese American participants had more visits (median 14 vs. 10, p = 0.005); were more often accompanied by family members (75% vs. 40%, p < 0.001); and had significantly lower rates of healthcare proxy documentation (35% vs. 55%, p = 0.006). There was no statistical difference in months between first CKD 4 visit and first dialysis. Both groups started dialysis at the same average eGFR and with similar rates of permanent dialysis access. Chinese American participants had significantly lower serum albumin at dialysis initiation (mean 3.3 g/dL vs 3.7 g/dL, p = 0.0003). Documentation reflected a low number of conversations about non-dialytic care, end-of-life planning, or palliative care in both groups across all visits.ConclusionThe time between CKD 4 and dialysis initiation was the same in both groups, suggesting a similar overall outcome of care. Chart documentation suggests that Chinese American participants had a significantly higher number of visits with nephrologists where discussion about dialysis was noted and were more likely to have a family member present at the visit. Fewer Chinese American participants completed healthcare proxies. Among all study participants, healthcare proxy, code status, and palliative care discussions were reported less frequently than expected. These findings highlight opportunities for collaboration between palliative care clinicians and nephrologists.

Evaluating the transition of adolescents and young adults with palliative care needs from pediatric to adult care

BackgroundThe transition from pediatric to adult healthcare poses significant challenges for adolescents and young adults (AYA), especially those with chronic conditions, yet most children receive inadequate transition preparation. Research on the transition for patients receiving palliative care services is particularly limited. We sought to address this gap in the literature. MethodsYoung adults aged 18 to 35 years who transitioned from the pediatric setting and received adult palliative care services at an urban academic medical center between the dates of February 1st, 2020 and July 1st, 2022 were identified retrospectively via electronic medical record. Chart review was used to investigate outcomes of interest, including use of pediatric palliative care services and timing of care conversations. ResultsOnly 23 % of patients interfaced with pediatric palliative care, despite all having childhood diagnoses. Pediatric palliative care exposure was associated with a significantly earlier median age of first adult palliative care encounter (19.63 versus 25.06, p = <0.001). Goals of care discussions, code status conversations, and healthcare proxy documentation occurred earlier if pediatric palliative care was involved (18.9 years versus 25.7 years, p < 0.001; 20.9 years versus 30.0 years, p < 0.001; 20.7 versus 28.9, p < 0.001). ConclusionsPediatric palliative care services were underutilized in AYA patients, but when used, were associated with earlier adult palliative care encounters, goals of care discussions, code status decisions, and health care proxy identification.

GERIATRICS TRAUMA CO-MANAGEMENT: PRELIMINARY DESCRIPTIVE DATA FROM A SINGLE ACADEMIC INSTITUTION

Abstract Background Traumatic injuries cause higher mortality and complications in older patients than in younger individuals. Orthogeriatric co-management programs improve outcomes and quality of care and may be a model for trauma management. We theorized that geriatricians could improve trauma care in older adults with the early identification of geriatric syndromes. Methods A retrospective chart review was conducted for patients aged &amp;gt; 65 years admitted to the trauma surgery service at a Level 2 trauma center between October 2022 and January 2023, who were co-managed by geriatricians as part of a pilot program. Results 67 patients were included in this study. The mean age was 81 (65-99), and 38% were male. The most common injuries were rib fractures (39%), subdural hematomas (32%), and spinal fractures (10%). Geriatric syndromes identified and managed by a geriatrician included frailty (47%), major or minor cognitive impairment (48%), delirium (19%), malnutrition (13%), and polypharmacy (65%), with a mean number of 6.7 home medications. As per Beers criteria, 63% of patients were taking inappropriate medications. Geriatrician-led interventions in advance care planning included identification and documentation of healthcare proxies (i.e., increased to 87% from 11% on admission) and goals of care conversations (54%). Conclusions Given the high prevalence of geriatric syndromes and complex medical and social needs in older patients with trauma, geriatric co-management may enable timely diagnosis and treatment of conditions that cause poor outcomes. Further research is warranted to assess the impact of geriatric co-management models on the long-term clinical outcomes in older individuals after injury.

Have Arguments For and Against Medical Aid in Dying Stood the Test of Time?

Have Arguments For and Against Medical Aid in Dying Stood the Test of Time?

“What Is the Most Important to Them?” Swiss Health Care Proxies, Nurses, and Physicians Discuss Planning Practices for Aged Care Residents Who No Longer Have Medical Decision-Making Capacity

Introduction: Multiple morbidities, including neurodegenerative diseases such as dementia, which result in diminished decision-making capacity (DMC), make care and care planning complicated for residential aged care facility (RACF) residents. While advance care planning has been highlighted as essential for ensuring that this population receives care that is coherent with their wishes, there are few models specifically designed for this population. This study aimed to explore the current practices for care planning and decision-making for Swiss RACF residents who no longer have medical DMC. Methods: Semi-structured focus groups were conducted with 23 nurses in three RACFs and with 13 physicians working in 9 RACFs. Semi-structured interviews were conducted with 18 health care proxies of 16 residents without DMC. Thematic analysis was conducted to identify the most salient themes across the dataset. Results: Analyses identified many collaborative processes between nurses, physicians, and health care proxies including family meetings, reconstructing residents’ presumed will, making anticipatory decisions, and documenting these decisions. These processes were, however, highly variable and differed between institutions and between residents within each facility, with a lack of standardization. This variability was highlighted to be problematic for information transmission within facilities and in case of hospital or facility transfer. Conclusions: These results highlight the importance of standardized yet flexible processes of care planning for people who no longer have DMC and provide insights for the development of such models specifically designed to address this problem.

Advance Care Planning: A Story of Trust Within the Family.

As the family usually plays a central role at the end of life, the quality of family relationships may influence how individuals approach advance care planning (ACP). Our study investigates the associations of trust in relatives with regard to end-of-life (EOL) issues-used as a proxy measure of family relationship quality-with individuals' engagement in EOL discussions, advance directive (AD) awareness, approval and completion, and designation of a healthcare proxy. Using nationally representative data of adults aged 55years and over from wave 6 (2015) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) in Switzerland (n = 1911), we show that complete trust in relatives is related to higher engagement in ACP. Subject to patient consent, the family should, therefore, be included in the ACP process, as such practice could enhance patient-centered EOL care and quality of life at the end of life.

Early palliative care referral may improve end-of-life care in end-stage liver disease patients: A retrospective analysis from a non-transplant center

BackgroundPatients with end-stage liver disease (ESLD) who are not transplant candidates often have a trajectory of rapid decline and death similar to patients with stage IV cancer. Palliative care (PC) services have been shown to be underutilized for such patients. Most studies examining the role of PC in ESLD have been done at transplant centers. Thus, determining the utilization and benefit of PC at a non-transplant tertiary center may help establish a standard of care in the management of patients with ESLD not eligible for transplant. MethodsWe conducted a retrospective analysis of adult (>18 years) patients with ESLD admitted to Rochester Regional Health (RRH) system hospitals from 2012 to 2021. Patients were divided into groups based on the presence or absence of PC involvement. Baseline characteristics were recorded. The impact of PC was assessed by comparing the number of hospitalizations before and after the involvement of PC, comparing code status changes, health care proxy (HCP) assignments, Aspira catheter placements, and frequency of repeated paracentesis. ResultsIn our analysis of 576 patients, 41.1% (237 patients) received a PC consult (PC group), while 58.9% (339 patients) did not (no-PC group). Baseline characteristics were comparable.However, their mean number of admissions significantly decreased (15.66 vs. 3.49, p < 0.001) after PC involvement. Full code status was more prevalent in the no-PC group (67.8% vs. 18.6%, p < 0.001), while comfort care code status was more common in the PC group (59.9% vs. 20.6%, p < 0.001). Changes in code status were significantly higher in the PC group (77.6% vs. 29.2%, p < 0.001). The PC group had a significantly higher mortality rate (83.1% vs. 46.4%, p < 0.01). Patients in the PC group had a higher likelihood of having an assigned HCP (63.7% vs. 37.5%, p < 0.001). PC referral was associated with more frequent use of an Aspira catheter (5.9% vs. 0.9%, p < 0.001) and more frequent paracentesis (30.8% vs. 16.8%, p < 0.001). ConclusionsIn conclusion, our study provides compelling evidence of the diverse advantages of palliative care for patients with end-stage liver disease, including reduced admissions, improved goals of care, code status modifications, enhanced healthcare proxy assignments, and targeted interventions. These findings highlight the potential significance of early integration of palliative care in the disease trajectory to provide comprehensive, patient-centered care that addresses the unique needs and preferences of individuals with advanced liver disease.