Integrating Palliative Care in End-Stage Liver Disease: An Interprofessional Perspective on Communication, Terminology, and Educational Gaps.

Abstract

End-stage liver disease (ESLD) carries a high symptom burden and unpredictable trajectory, yet palliative care (PC) is often introduced late. Timely, needs-based PC integration remains inconsistent, and interprofessional perspectives are poorly understood. We surveyed 55 clinicians across five specialties (transplant hepatology, transplant surgery, general gastroenterology, general internal medicine, and PC) at a single academic institution in Chicago, IL. Domains included timing of PC referral, symptom management comfort, terminology preferences, perceived barriers, and role clarity. A cross-sectional survey administered via REDCap evaluated attitudes toward PC integration and interdisciplinary role delineation in ESLD care. Eighty-nine percent of respondents endorsed PC for transplant-ineligible patients, although opinions varied on pretransplant integration. Significant specialty-based differences emerged in perceived barriers, symptom management confidence, and sense of PC ownership. PC clinicians reported the highest confidence across symptom domains, while transplant providers reported discomfort with advance care planning and complex symptom management. Divergent views on the use of long-term abdominal drains and role ownership highlighted variability in clinical priorities, practice patterns, and thresholds for intervention. Despite broad support for PC in advanced ESLD, integration remains limited by role uncertainty, training gaps, and stigma. Specialty-specific discomfort with holistic assessment and symptom management underscores the need for targeted education and co-management models. Enhanced collaboration and role clarity are critical to ensure equitable PC access across the ESLD trajectory.