Veteran-Centered Care for Advanced Liver Disease (Vet-CALD)
NCT06068491
Summary
Advanced liver disease is a serious illness that disproportionately affects Veterans, many of whom hope for curative liver transplantation. However, too few receive a transplant and most continue to suffer from increasing symptoms and hospitalizations. The proposed project uses a whole person, Veteran-centered approach that identifies Veterans with advanced liver disease using a population-based health management system and integrates curative and early supportive care using a telemedicine-based nurse care counselor to (1) discuss patient's understanding of illness severity and prognosis, (2) identify priorities and care preferences and (3) align curative and supportive care options to achieve patient priorities. Study outcomes include changes in (1) rates of consideration for liver transplantation, and (2) completion of serious illness discussions. Findings will inform adaptations to the intervention and facilitators for its dissemination.
Eligibility
Inclusion Criteria: * Patients will be between 18 and 80 years of age * Patients must be Veterans * Patients must have been in care at one of the recruiting sites with 1 or more encounters in primary care or GI/Hepatology in the last 24 months * Patients must have advanced liver disease, defined by ICD-10 codes for cirrhosis complications (ever) or MELD 3.0 \>12 or MELD-Na \>12 or Fibroscan LSM \>20kpa Exclusion Criteria: * Non-Veteran patients * Patients who do not speak English, do not have access to a telephone or computers, or who are unable to complete a valid informed consent form after three attempts * Patients who have already made significant progress toward our endpoints: a) with prior history of liver transplantation, or b) on the liver transplant waiting list, or c) had formal evaluation for liver transplantation in the past 3 years * Patients with very limited life expectancy (advanced cancer, acute-on-chronic liver failure, and hospice patients) * Patients hospitalized, or in long term facilities or nursing homes at the time they meet inclusion criteria * Patients with chart diagnosis of uncontrolled mental health or schizophrenia
Conditions2
Locations8 sites
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NCT06068491