Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis: A Pilot Study

Arpan Patel, Nina Kogekar, Ritu Agarwal, Cynthia Cohen, James Phillip Esteban, Kamron Pourmand, Eugenia Tsai, Alyson Harty, Andre Pelham-Braithwaite, Ponni Perumalswami, Douglas Dieterich, Thomas Schiano

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Despite significant morbidity and mortality among patients with decompensated cirrhosis, reported rates of advance directive (AD) completion and goals of care discussions (GCDs) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention. Measures: Rates of AD and GCD completion, as well as self-reported barriers to ACP. Intervention: Provider-led ACP in patients with decompensated cirrhosis without a prior documented AD. Outcomes: Sixty-two patients were seen over 115 clinic visits. After the intervention, AD completion rates increased from 8% to 31% and GCD completion rates rose from 0% to 51%. Women (P = 0.048) and nonmarried adults (P = 0.01) had greater changes in AD completion compared to men and married adults, respectively. Needing more time during visits was seen as the major barrier to ACP among providers. Conclusions/Lessons Learned: Addressing provider and system-specific barriers dramatically improved documentation rates of ACP.

Original languageEnglish
Pages (from-to)864-870
Number of pages7
JournalJournal of Pain and Symptom Management
Issue number4
StatePublished - Apr 2020


  • Advance care planning
  • advance directives
  • cirrhosis
  • goals of care


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