Identifying palliative care needs in a Portuguese liver unit

• Published in: Liver international Vol. 38; no. 11; pp. 1982 - 1987
• Main Authors: Carvalho, Joana Rita, Vasconcelos, Mariana, Marques da Costa, Pedro, Marinho, Rui Tato, Fatela, Narcisa, Raimundo, Miguel, Carvalhana, Sofia, Ramalho, Fernando, Cortez‐Pinto, Helena, Velosa, José
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-11-2018
• Subjects: Aged; Cirrhosis; Consultation; end‐stage liver disease; Female; Health care; Health Services Needs and Demand - statistics & numerical data; Hospice care; Hospital Mortality; Humans; identification; Liver; Liver cirrhosis; Liver Cirrhosis - mortality; Liver Cirrhosis - therapy; Liver diseases; Logistic Models; Male; Middle Aged; Morbidity; NECPAL tool; Palliation; Palliative Care; Patient Care Planning; Patients; Portugal - epidemiology; Prospective Studies; ROC Curve; Surveys and Questionnaires; Portugal; end-stage liver disease; identification; palliative care; NECPAL tool
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13865

Background & Aims
Chronic liver disease is a major worldwide cause of morbidity and mortality. Palliative care policies are not clearly established in chronic liver disease. The NECPAL CCOMS‐ICO© (NECesidades PALiativas/Palliative Needs) is a tool to identify palliative care needs, including a section for liver disease. Aim: The aim of this study was to identify palliative care needs in liver patients hospitalised in a tertiary referral Liver Unit.
Methods
Single‐centre prospective observational study. One hundred and twenty patients with cirrhosis were included and NECPAL questionnaire was applied to all patients in a 7‐month period.
Results
84.2% of patients were considered as requiring palliative intervention; however, clinicians identified those needs only in 65.8% of the cases and caregivers in 6.7% of the cases; less than 8% of the patients were referred for palliative care consultation. An excessive use of healthcare resources (positive answer to question 3) was strongly associated with a positive need for palliative care (positive NECPAL): OR 7.305, CI 95% 2.54‐20.995, P < .001). An excessive use of healthcare facilities has a sensitivity of 84.2% and a specificity of 42.1% for prediction of a positive NECPAL result (AUC 0.710, 95% CI 0.570‐0.850, P = .004).
Conclusions
The NECPAL CCOMS‐ICO© represents a feasible and easy‐to‐use tool to identify palliative care needs in patients with chronic liver disease.