Inpatient Specialty-Level Palliative Care is Delivered Late in the Course of Hepatocellular Carcinoma and Associated with Lower Hazard of Hospital Readmission.

Abstract: Context Little is known about receipt of specialty-level palliative care by people with hepatocellular carcinoma (HCC), or its impact on healthcare utilization. Objectives Identify patient characteristics associated with receipt of specialty-level palliative care among hospitalized HCC patients and measure association with time to readmission. Methods We used logistic regression to examine relationships between receipt of inpatient palliative care consultation by HCC patients at an academic center (N=811, 2012–2016), and clinical and demographic covariates at index hospitalization. We used a survival analysis model accounting for competing risk of mortality to compare time to readmission among individuals who did or did not receive palliative care during the admission and performed a sensitivity analysis using kernel weights to account for selection bias. Results Overall, 16% received inpatient palliative care consults. Those who received consults had worse laboratory values than those who did not. In a multivariable model, higher MELD-Na, receipt of sorafenib, and higher pain scores were significantly associated with increased odds of palliative care, while liver transplantation and admission to a surgical service were associated with lower odds. For time to readmission (2,076 hospitalizations for 811 individuals with 175 palliative care visits), the sub-hazard ratio for readmission for patients who received consults was 0.26 (95% Confidence Interval [CI] 0.18-0.38) and 0.35 (CI 0.24-0.52) with a kernel-weighted sample. Conclusion Inpatient palliative care consultation was received by individuals with more advanced disease, and was associated with lower readmission hazard. These findings support further research and the development of HCC-specific programs that increase access to specialty-level palliative care.