PTH-48 Patients’ perspectives of palliative and end-of-life care in advanced liver disease: Systematic review of literature

Introduction Liver disease, a major cause of death, worldwide affects younger people compared to other major causes of death. Though guidelines are emerging on what good end-of-life (EOL) care in liver disease should look like, little appears to be known about patients’ perspectives regarding palliative and EOL care, even though they are most affected by these guidelines. Methods Aim Explore current knowledge and understanding of patients’ lived experiences, perspectives, and expectations in relation to palliative and EOL care in advanced liver disease. Design Systematic review with thematic synthesis complying to the ENTREQ Statement. Setting and participants Systematic search of databases (Ovid Medline and Web of Science) to identify qualitative studies, in English, exploring patients’ perspectives of palliative and EOL care in advanced liver disease. Results Only eight articles, amongst them involving 166 patients, met the study criteria. Themes demonstrated repeated hospital admissions towards the end of life, lack of coordinated care in community and barriers in discussion about palliative care in end stage liver disease due to lack of confidence amongst professionals and a negative view about palliative care amongst patients and carers. Emotional, financial and disability related needs of patients and their carers are often neglected. (Table 1) Conclusions Further research into perspectives of patients with advanced liver disease and their carers regarding palliative and EOL care will help improve the implementation of patient-focussed palliative care, advance care planning and EOL care. Research should also be done into the barriers to EOL discussions so that they can be held earlier with the aim of improving patient and carer quality of life and outcomes. It would be interesting to see the comparison of the attitude to, and expectations from, palliative care among patients and their caregivers from different parts of the world where the aetiological spectrum of liver disease, the social construct of healthcare and availability of palliative care differs significantly.