A mixed methods process evaluation of a collaborative outpatient palliative care clinic for patients with end-stage liver disease
Bibliographic record
Abstract
BACKGROUND: Patients with end-stage liver disease (ESLD) have significant symptoms and limited prognosis, yet receive less palliative care (PC) than patients with cancer. The optimal outpatient PC model for patients with ESLD remains unclear. OBJECTIVE: We used process evaluation methodology to evaluate a novel PC clinic for patients with ESLD in Ottawa, Canada. DESIGN: We conducted a convergent parallel mixed methods study, informed by a logic model and process evaluation framework co-designed with a caregiver partner. Qualitative inputs included semi-structured interviews conducted with patients, family caregivers, as well as PC and hepatology clinicians, and analyzed using applied thematic analysis. Quantitative inputs included data collected through a retrospective chart review, analyzing healthcare utilization up to six months before and after consultation. PARTICIPANTS: Interviews conducted with eight healthcare providers (HCPs) and 13 patients and caregivers. Chart review performed for 46 patients seen in the clinic between October 2020 and June 2023. INTERVENTION: An outpatient PC hepatology collaboration clinic, led by specialist PC physicians. APPROACH: Qualitative and quantitative data were analyzed independently and then triangulated for overall interpretation. KEY RESULTS: The evaluation demonstrated the achievement of the outcomes in the logic model and process evaluation domains. Interviews highlighted high satisfaction among HCPs, patients, and caregivers, and effective collaboration between the PC and hepatology teams. Perceived barriers include the burden of in-person appointments. Quantitative results indicated decreased acute healthcare utilization in the six months following PC consultation compared to the six months prior. Over 50% of the deceased patients died outside of the hospital. CONCLUSION: The early outpatient PC clinic provides high-quality, collaborative care for patients with ESLD; study findings suggest an association with reduced acute healthcare utilization and increased likelihood of death occurring outside the hospital. This model represents a promising approach for PC in ESLD and other non-malignant illnesses.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".