Integrating Palliative Care in End-Stage Liver Disease: A Multidisciplinary Perspective on Communication, Terminology, and Educational Gaps

Background End-stage liver disease (ESLD) carries a high symptom burden and mortality, yet palliative care (PC) is often introduced late. Timely, needs-based PC integration remains inconsistent and multidisciplinary perspectives poorly understood. Measures: We surveyed 55 clinicians across five specialties (transplant hepatology, transplant surgery, gastroenterology, general internal medicine, and palliative care) at a single academic institution in Chicago, IL. Domains included timing of PC referral, symptom management comfort, terminology preferences, perceived barriers, and role clarity. Intervention: A cross-sectional survey administered via REDCap evaluated attitudes toward PC integration and interdisciplinary role delineation in ESLD care. Outcomes: 89% of respondents endorsed PC for transplant-ineligible patients, though opinions varied on pre-transplant integration. Significant specialty-based differences emerged in perceived barriers, symptom management confidence and 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 use of long-term abdominal drains and role ownership highlighted variability in clinical priorities, practice pattern, and threshold for intervention. Conclusions/Lessons: 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.