Table 3.

Overview of Included Studies

Study (author, year of publication)	Study design	Disease process	Intervention or exposure	Setting (inpatient, outpatient, home, both, unknown)	No. of patients (control, experimental)		Outcome measured (HRU, EOLC, PRO, Survival)	Impact on outcome
Studies with low risk of bias		Liver cancer	Hospice	Inpatient	729	729	HRU	Hospice care group had decreased total cost, number of procedures, ICU admissions.
(Hwang et al., 2013)23	Retrospective cohort						EOLC	Hospice care group had less CPR, defibrillation/cardioversion, and epinephrine injection.
(Sanoff et al., 2017)25	Retrospective cohort	HCC	Hospice	Unknown	5056	2936	HRU	Less likely to be hospitalized, have an ICU stay.
							EOLC	Less likely to die in the hospital.
Studies with mod. risk of bias	Quality improvement	DC and HCC	Palliative care consultation	Outpatient	30	30	PRO	Improvement of symptom burden and depressive symptoms.
(Baumann et al., 2015)29
Studies with high risk of bias		Liver cancer	Hospice	Both	644	206	HRU	Hospice was associated with lower costs in the last month of life.
(Chiang and Kao, 2015)28	Retrospective cohort						Survival	No difference in survival between getting hospice and usual care.
(Kao and Chiang 2015)24	Retrospective cohort	Liver cancer	Hospice	Both	462	2630	EOLC	Hospice group with less CPR in the last month of life.
								No difference in receiving chemotherapy in the last 2 weeks of life.
								Hospice group with fewer ICU admissions.
							HRU	Short-hospice group (<1 month) had more ER visits and hospital admissions.
(Lamba et al., 2012)30	Prospective cohort, pre/post study	Pre and post-transplant liver disease in surgical ICU	Palliative care program	Inpatient	79	104	EOLC	Intervention showed an increase in goals of care conversations on physician rounds, increased DNR status, and increase in withdrawal of life support before death.
							HRU	No difference in ICU or hospital LOS.
(Patel et al., 2017)26	Retrospective cohort	DC and HCC	Palliative care encounter	Inpatient	17,358	42,328	HRU	Lower overall costs with palliative care.
(Riolfi et al. 2013)27	Retrospective cohort	HCC	Palliative care service	Home	11	15	HRU	No difference in mean days in the hospital in last 2 months of life, mean number of hospitalizations in last 2 months of life.
							EOLC	Patients who received palliative care at home, tended to die more at home.

HCC, hepatocellular carcinoma; DC, decompensated cirrhosis; liver cancer, did not designate specifically HCC; LOS, lengths of stay; ICU, intensive care unit, HRU, healthcare resource utilization; EOLC, end-of-life care; PRO, patient-reported outcomes; CPR, cardiopulmonary resusciation; ER, emergency room; DNR, do-not-resuscitate.