The role of primary care in liver disease: early detection and end of life care? A qualitative study of the perceptions of primary health care professionals

Liver disease is the third commonest cause of early death in the UK and the number of people with the disease is growing. The main causes, alcohol, obesity and viral hepatitis are well known, but many people show no signs of illness until irreversible liver damage and scarring (cirrhosis) have developed. One in four patients are not diagnosed until they are admitted to hospital with advanced disease, when it is too late to prevent further damage. With so many people dying from liver disease, providing good end of life care is crucial. The symptoms of terminal liver disease are often difficult to treat, but few patients see a palliative care specialist, and a high proportion die in hospital.

Experts in liver disease, politicians and policy-makers all agree that urgent action is needed, and primary care has been identified as an area where care for liver patients is poor. General practitioners have a particularly important part to play at the beginning and end of the illness; identifying patients who need further tests, treating symptoms, and making sure that palliative care is in place. We know that current blood tests are not very good at identifying people at risk of serious liver disease, and that the results are difficult to interpret. In addition, other reasons why primary care for these patients may not be effective need to be explored. 

In this study, we will interview up to thirty health professionals in primary care, to explore how they see their role in detecting liver disease and providing care at the end of life, including the main challenges in their work. These interviews will help us to understand why primary care for liver disease is in its current state, and how it may be able to improve patients’ outcomes in the future.