{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T23:15:52Z","timestamp":1764890152053,"version":"3.46.0"},"reference-count":33,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"unspecified","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Palliative Care Centre for Excellence in Research and Education, Dover Park Hospice, Singapore","award":["PalC-RG-23\/P002"],"award-info":[{"award-number":["PalC-RG-23\/P002"]}]},{"name":"NHG Health LKCMedicine Clinician Scientist Preparatory Programme","award":["CSPP-23-01-01"],"award-info":[{"award-number":["CSPP-23-01-01"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,25]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cirrhosis is a major cause of morbidity and mortality. Patients with decompensated cirrhosis, or end-stage liver disease (ESLD), have a high symptom burden and an increased mortality risk. Yet, the uptake of palliative care in patients with ESLD remains low and variable. Despite robust evidence of the value of home palliative care in other advanced diseases, this has not been well studied in patients with ESLD. Hence, the primary aim of this study is to explore the implementation, feasibility and acceptability of home palliative care in patients with ESLD and healthcare professionals. We also aim to describe its impact on the quality of life (QoL), mood, symptom burden, caregiver burden and healthcare utilisation of patients with ESLD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The study is a single-centre, mixed-methods feasibility study. Eligible patients include those with decompensated liver cirrhosis who are admitted under the gastroenterology and hepatology service and fulfil the Supportive and Palliative Care Indicator Tools (SPICT) criteria. Recruited patients will be followed up by a multi-disciplinary homecare team led by a palliative care physician for 6\u2009months. Both qualitative and quantitative measures will be used to evaluate the primary aim and include the uptake of the service by both eligible patients and physicians. Semistructured interviews with key stakeholder groups will be conducted to determine their perspectives and experiences. Secondary outcome measures include changes in health-related QoL using the Chronic Liver Disease Questionnaire, depression severity, goals of care discussions, patient symptom burden, caregiver burden and healthcare utilisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study will adhere to the Declaration of Helsinki and has been approved by the research ethics committee of the National Healthcare Group (DSRB (Domain Specific Review Board) reference: 2023\/00852). Results will be submitted for publication in international peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103784","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T09:00:59Z","timestamp":1760605259000},"page":"e103784","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Examining the implementation of home-based palliative care for patients with end-stage liver disease (HoPE): a protocol for a feasibility study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3104-9224","authenticated-orcid":false,"given":"Chung Yau","family":"Nah","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Woodlands Health, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"WanFen","family":"Yip","sequence":"additional","affiliation":[{"name":"Department of Health Services and Outcomes Research, National Healthcare Group, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalaiyarasi","family":"Kaliyaperumal","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sek Hwee","family":"Yung","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore"},{"name":"Dover Park Hospice, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siew Chin","family":"Chia","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore"},{"name":"The Palliative Care Centre for Excellence in Research and Education, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allyn","family":"Hum","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore"},{"name":"The Palliative Care Centre for Excellence in Research and Education, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"2025120415074057000_15.10.e103784.1","first-page":"245","article-title":"The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"5","year":"2017","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025120415074057000_15.10.e103784.2","unstructured":"Epidemiology & disease control division . 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