Comparison of Palliative Care Access Between Patients With Liver Cirrhosis and Hepatocellular Carcinoma: Nationwide Population-Based Study.

BACKGROUND: In August 2017, Republic of Korea (South Korea) expanded its national hospice and palliative care program to cover several serious non-cancer illnesses, including liver cirrhosis (LC). We aimed to examine the access of palliative care services among adults who died of LC compared with those who died of hepatocellular carcinoma (HCC). METHODS: We conducted a population-based retrospective cohort study using National Health Insurance Service data, including adults who died of LC or HCC between 2018 and 2022. Associations between cause of death (LC vs. HCC) and advance care planning (ACP) completion and receipt of hospice and palliative care services were estimated using multivariable logistic regression. RESULTS: The final analytic cohort comprised 44,787 patients died from LC (71% women; mean age, 66 years) and 58,685 patients died from HCC (67% women; mean age, 70 years). Patients with LC had significantly lower rates of ACP completion (23.1 vs. 31.2%; adjusted odds ratio [aOR], 0.765; 95% confidence interval [CI], 0.723-0.809; P < 0.001) and hospice and palliative care service utilization (3.7% vs. 9.1%; aOR, 0.558; 95% CI, 0.499-0.623; P < 0.001) compared to those with HCC. CONCLUSION: Despite nationwide coverage of hospice and palliative care services, LC decedents remained less likely than HCC decedents to complete ACP or receive hospice and palliative-care services in Korea.