Evidence-Based Frameworks Increase Engagement in Serious Illness Communication Conversations for Patients With Cirrhosis

Background Serious illness communication occurs with <10% of outpatients with end-stage liver disease (ESLD), despite high morbidity and mortality. We determined the feasibility of assessing changes in readiness for serious illness communication engagement following an evidence-based intervention. Methods We conducted a single group pre-post evaluation of a pilot intervention in adults with ESLD in an outpatient hepatology clinic. Study intervention included a standard outpatient hepatology visit with addition of a serious illness conversation performed by one hepatologist trained in evidence-based communication frameworks. Serious illness communication engagement was measured using a validated survey at baseline and over 6 months. Sociodemographic, clinical information, and post-study qualitative data were collected. Results 31 participants enrolled and 22 participants (70.9%) completed the 6-month assessment. The mean age was 53 years, 42% (n = 13) were female, 55% (n = 17) self-identified as non-White and/or Hispanic ethnicity, 60% (n = 18) had more than a high school education, and 65% (n = 20) were not partnered. SIC readiness improved immediately following the SIC intervention (mean 4.0, SD 1.0, P < 0.001), and was maintained at 3 months (mean 4.0, SD 1.1, P < 0.001) and 6 months (mean 3.8, SD 1.3, P = 0.002). Post-study qualitative data showed participants were comfortable with serious illness communication, desired provider initiation and family involvement with a preference for outpatient conversations with a known provider. Conclusion Our hepatologist-led, evidence-based intervention resulted in clinically meaningful and statistically significant increases in serious illness communication readiness for patients with ESLD.