Our question: Can a longitudinal model of specialty aligned inpatient palliative care get more patients happier and healthier to and through transplant 🤔? We will know more at the end of our trial!

God bless you and this program. Seriously. Thank you for the work you do.

Amongst the palliative care domains, it feels like the domain of moral/existential/spiritual needs often gets short shrift unless patients are truly end of life. I wonder if inverting this pyramid to make existential needs the base, and not the peak, opens up a wider world of therapeutic support?

In a space in which serious illness, psychological distress, and often addiction can so closely overlap, we have found that using a moral/existential/spiritual frame in serious illness convos and exploring coping is an almost necessary consideration: “How to live a better life with liver disease”

I enjoyed reading this - thank you. I’ve been thinking about coping a lot in context of serious illness conversations in hepatology/transplant. In our inpatient LiverPal work, our team talks about how our therapeutic alliance often starts with exploring our patients’ existential/spiritual distress.

Lets invest in true collaborative care with our palliative care colleagues-this is more than just a triggered referral. Working with my #LiverPal team has been the biggest professional joy of my life. Doing so has required YEARS of longitudinal teamwork and culture change. But its been so worth it.

We also need to invest in bidirectional collaboration to grow specialty-aligned palliative care and support our PC clinicians in learning disease-specific symptoms, common treatments, and complications that impact prognosis and outcomes of our patients @releiter.bsky.social

https://buff.ly/3Bw36Yu

Authors: "A multipronged effort is needed to meaningfully move the needle...detailed measurement of individual physical, psychological, sociocultural, and other palliative care needs instead of using screening tools that merely identify these unmet domains of needs at a superficial level."

PREACH

We need population-specific approaches to symptom management, serious illness conversations, end-of-life care. This requires foundational research. We need to ensure that outcomes that are so often used in PallOnc interventions are appropriate, responsive, and valid in non-cancer populations.

And not just ICU but also inpatient/outpatient PC interventions as well. I might go further and say that the copy-and-paste approach from PallOnc trials may not only show no benefit but may have the capacity to cause harm (extra burden of visits, care not aligned with population-specific needs)

Thus I could not agree more with the authors: "A heterogeneous array of interventions and outcomes founded on cancer-based models of palliative care (regardless of how they are tailored or targeted) may offer limited benefit above what contemporary ICU care can deliver to patients and families."

As a hepatologist who is a proud member of a palliative oncology research lab I'm both inspired by my mentors but have also had a deep realization for years that a "copy-and-paste" approach using PC models developed in cancer cannot, will not, and should not be the way to build #palliativehepatology