Early communication strategies improve end of liver transplant patients’ lives

By Sarah Guy, medwireNews Reporter

A multidisciplinary communication intervention involving physicians and family members of liver transplant (LT) patients treated in surgical intensive care units (ICUs) can improve end-of-life care, show study results.

The two-part intervention allowed earlier consensus of care goals between the two groups, including earlier institution of Do Not Resuscitate (DNR) orders, which allowed more time for families to spend time with their relatives before death, say the study authors.

The findings also show that earlier palliative care in this population can be integrated alongside an aggressive curative care focus without affecting mortality rates.

"Early psychosocial support may be critical for future end-of-life discussions, particularly in the LT population where there are high hopes/expectations of life-saving surgery and usually no prior approach to advance care planning," say Anne Mosenthal (University of Medicine and Dentistry of New Jersey, Newark, USA) and co-investigators.

The team collected data before (March 2003 to March 2004, baseline) and after (March 2004 to May 2005) implementing the structured palliative care program. The Quality of Dying and Death questionnaire was completed by families and/or clinicians to evaluate LT patients' end-of-life experiences.

Part one of the intervention involved a palliative care assessment at admission outlining prognosis, advance directives, and pain - among other factors - to family members, and part two involved an interdisciplinary family meeting held within 72 hours of admission to discuss elements such as likely patient outcomes and treatment goals.

In all, 79 LT patients were admitted to the surgical ICU during the baseline period and 104 during the intervention phase. There were 21 and 31 deaths during these times: a nonsignificant difference.

A total of 85% and 58% of patients received parts one and two of the intervention, respectively. Death and discharge, among other reasons, prevented full completion.

Goals-of-care discussions on physician rounds increased from 2% at baseline to 39% postintervention, designated DNR status increased significantly among those who died, from 52% at baseline to 81%, and the mean time from admission to DNR status decreased from 38 to 19 days, report Mosenthal et al in the Journal of Pain and Symptom Management.

The mean time from DNR order to patient death increased, from 2 to 4 days, which "is valuable as it provides an opportunity for the family to say their goodbyes, come to terms with the death of their loved one... and provide time for rituals," the researchers contend.

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