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b'Patients with end stage liver disease and decompensated cirrhosis have an average life expectancy of 2 years without transplant.\\xa0 Outcomes are worse among those who are frail.\\xa0 Symptoms are common, including pain, ascites, encephalopathy, and pruritus.\\xa0 Patients with end stage liver disease are often some of the most disadvantaged patients we care for.\\xa0 Caregiver burden is immense; divorce is common.\\xa0 Some will go on to receive a transplant, but many will not.\\xa0 Many are confused about the diagnosis and feel poorly supported.\\xa0 Prognosis is fraught, as the worse your prognosis (i.e. lower your chance of survival), the higher you move on the transplant list.\\xa0 Advance care planning is rare (or serious illness communication for those of you who don\\u2019t consider this advance care planning).\\xa0 Outcomes of in-hospital CPR are worse for patients with end stage liver disease than outcomes for patients with advanced cancer. Though integration of geriatrics and palliative care into the care of patients with end stage liver disease holds obvious potential, major barriers remain.\\xa0\\xa0

In this week\\u2019s podcast, we talk with Jen Lai, Ricky Shinall, Nneka Ufere, and Arpan Patel about end stage liver disease from a geriatrics and palliative care perspective.\\xa0 We talk about the tension patients face between putting on the \\u201cbest face\\u201d to be listed for transplant (e.g. full code, goals focused on extending life).\\xa0 We talk about the potential and limitations of the MELD score for prognosis, and how frailty further stratified risk for older patients with end stage liver disease.\\xa0 We discuss what is needed in terms of improved communication around the time of diagnosis, creating a safe space for serious illness communication, and resources for patients and caregivers (including this Canadian information resource). And we have a round robin about treatment of common and challenging symptoms \\u2013 yogurt makes a surprise appearance.

And\\u2026Radiohead! Great request\\u2026thank you Nneka!

-@AlexSmithMD