Hepatologist-led palliative care matches specialist care for cirrhosis and cancer patients

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JAMA internal medicine Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Verma Manisha, Navarro Victor, Kosinski Andrzej, Taddei Tamar, Kalman Richard, Barritt Iv A Sidney, … PubMed ↗ NCT03540771 ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Hepatologist-delivered palliative care is noninferior to specialist care for improving quality of life in advanced liver disease.

This cluster randomized clinical trial, conducted across 19 US medical centers, evaluated a palliative care intervention for adults with decompensated cirrhosis or hepatocellular cancer. The study enrolled 935 patients with a life expectancy of at least six months who had not received a liver transplant or palliative care in the prior three months. The intervention involved palliative care delivered by hepatologists trained in palliative care, comprising four structured visits over three months. The comparator was palliative care delivered by palliative care specialists, also using a structured checklist over the same period.

The primary outcome was the change in quality of life at three months, measured by the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) total score. Results demonstrated noninferiority of the hepatologist group compared to the consultative specialist group, with an adjusted mean difference of 0.98 (95% CI, -2.86 to 4.83; P = .01). Superiority was not found, indicating that hepatologist-led care was comparable to specialist-led care for improving quality of life in this population.

Secondary outcomes included changes in symptom burden, distress, depression, patient satisfaction, and mortality. Symptom burden and depression improved in both groups without significant between-group differences. Patient satisfaction showed greater improvement in the hepatologist group, with an adjusted mean difference of 3.37 versus 0.91 for the specialist group (P = .002). Mortality was similar between the groups, and no safety events were reported.

The trial's findings support the integration of palliative care into hepatology practice, suggesting that trained hepatologists can effectively deliver palliative care comparable to specialists. This approach may enhance patient satisfaction and optimize resource use in managing advanced liver disease. The study highlights the importance of structured palliative care checklists and training for hepatologists to ensure consistent, high-quality care.

Limitations of the study include the short follow-up period of three months and the lack of reported safety data. The population was limited to US adults with specific eligibility criteria, which may affect generalizability. Future research should explore longer-term outcomes and the impact of this intervention on healthcare utilization and costs.

In practice, this trial provides evidence that hepatologists can play a key role in delivering palliative care to patients with advanced liver disease, potentially improving patient satisfaction and maintaining quality of life. The structured approach using checklists can be adopted in other settings to standardize care and ensure comprehensive management of symptoms and psychosocial needs.

Overall, the study underscores the value of collaborative care models in hepatology and palliative medicine, offering a feasible strategy to enhance patient-centered care for those with decompensated cirrhosis or hepatocellular cancer.

Study Details

Study typeRct

Sample sizen = 935

EvidenceLevel 2

Follow-up3.0 mo

PublishedJun 2026

PMID41973444

TrialNCT03540771

View Original Abstract ↓

IMPORTANCE: Palliative care improves quality of life (QoL) in advanced illnesses, but data in end-stage liver disease (ESLD) are limited. It is unknown whether palliative care delivered by hepatologists is effective when compared with palliative care specialists. OBJECTIVE: To compare the effectiveness of palliative care delivered by trained hepatologists with the care delivered by conventional palliative care specialists in improving QoL at 3 months. DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness cluster randomized trial for US patients treated for ESLD in 19 US medical centers compared a palliative care intervention delivered by palliative care-trained hepatologists (hepatologist group; 11 centers) with palliative care specialists (consultative group; 8 centers). Eligible patients were US adults with either decompensated cirrhosis or hepatocellular cancer who had a life expectancy of at least 6 months, had not received or scheduled liver transplantation, or had not received palliative care in the prior 3 months. Hepatologists in hepatologist group alone received primary palliative care training. Data collection occurred from January 2019 through June 2025; analysis was conducted from July to September 2025. INTERVENTION: Participants received 4 palliative care visits over 3 months delivered by either palliative care-trained hepatologists or palliative care specialists, using a structured palliative care checklist. MAIN OUTCOMES AND MEASURES: Superiority or a priori noninferiority of the effect of palliative care delivered by hepatologists vs palliative care specialists on change in QoL at 3 months, measured by the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) total score (higher scores indicating better QoL). Secondary outcomes included change in symptom burden, distress, depression, satisfaction from baseline to 3 months, and mortality. RESULTS: A total of 935 patients were enrolled (mean [SD] age, 63.0 [10.3] years; 275 female [29%]; 130 Hispanic ethnicity [14%]; 144 Black [15%], 736 White [79%]). From baseline to 3 months, QoL improved in both groups (adjusted mean: hepatologist, 8.01 [95% CI, 5.38 to 10.65]; consultative, 7.02 [95% CI, 4.34 to 9.71]; both P < .001). Although superiority was not found in change in QoL, prespecified noninferiority analysis showed that the improvement in the hepatologist group was noninferior to the consultative group (adjusted mean difference, 0.98 [95% CI, -2.86 to 4.83]; P = .01). Symptom burden (adjusted mean difference, -7.52 [95% CI, -9.89 to -5.15] vs -5.31 [95% CI, -7.60 to -3.03]) and depression (adjusted mean difference, -1.18 [95% CI, -1.78 to -0.57] vs -0.90 [95% CI, -1.49 to -0.31]) improved in both groups, without significant between-group differences. Patient satisfaction improved more in the hepatologist group compared with the palliative care group (adjusted mean difference, 3.37 [95% CI, 2.24 to 4.49] vs 0.91 [95% CI, -0.15 to 1.96]; P = .002). Mortality at 3 months was similar in both groups. CONCLUSIONS AND RELEVANCE: This cluster trial found that palliative care delivered by trained hepatologists was comparable with palliative care delivered by palliative care specialists in improving QoL in patients with ESLD and was associated with greater improvement in patient satisfaction, demonstrating the effectiveness among enrolled patients. TRIAL REGISTRATION: ClinicalTrials.Gov Identifier: NCT03540771.