Philadelphia, April 2026
Advanced liver disease (ALD) occurs when significant scarring causes the liver to lose function. Patients with ALD often have serious health challenges but have limited access to palliative care that could improve their quality of life. A new multicenter trial led by Manisha Verma, MD , and Victor Navarro, MD , at Jefferson Einstein Philadelphia Hospital demonstrates a new approach that could potentially transform access to palliative care for patients with ALD and address a major care gap.
In the PAL LIVER trial , a large cluster-randomized study conducted across 19 U.S. centers, researchers evaluated whether hepatologists trained in primary palliative care could match the effectiveness of palliative care specialists in delivering quality-of-life benefits to patients with ALD, including those with decompensated cirrhosis and liver cancer. With 935 patients enrolled, this is one of the largest trials to date in liver disease palliative care.
Palliative care was provided to patients (559 caregivers are also included in the study) over four monthly visits by either a palliative care specialist utilizing a standard checklist or by a hepatologist trained to deliver palliative care using the same standardized checklist . The study findings, published in JAMA Internal Medicine , found that quality of life improved significantly in both groups over three months, with care delivered by hepatologists matching that of palliative specialists in improving quality of life. Symptom burden improved similarly in both groups, and short-term mortality was also comparable between groups.
“These results challenge traditional care models,” says Dr. Verma, associate chair and director of research for the Department of Medicine at Jefferson Einstein Philadelphia Hospital and first author of the study. “We’ve demonstrated that non-specialists can effectively deliver structured palliative care with the appropriate training.”
The approach could be a timely, scalable solution in the face of a growing workforce shortage in palliative care. “By embedding palliative care within hepatology clinics, this would allow earlier and more widespread access for patients who might otherwise not receive it,” adds Dr. Verma
Furthermore, patients reported higher satisfaction with hepatologist-delivered care. This suggests patients may value receiving palliative care from clinicians already managing their liver disease, with improved continuity and coordination in their care. With patient outcomes and engagement at the forefront of this trial, this study was funded by the Patient Centered Outcomes Research Institute ( PCORI ). The team developed a patient and caregiver research advisory board with participants from multiple centers, who contributed to the study throughout.
“At the time the grant was awarded, this was one of the largest grants funded by PCORI for palliative care research,” says senior author Dr. Navarro, chief clinical officer for the central region of Jefferson Health. “Our patient-centered trial has the ability to significantly transform the patient experience for those suffering with ALD.”
The researchers plan to scale the integration of palliative care into routine hepatology practice, by developing standardized training for providers and comprehensive patient education. The team also hopes to leverage artificial intelligence-driven approaches to enhance the adoption and dissemination of the model.
Dr. Verma and Dr. Navarro, both faculty at Sidney Kimmel Medical College, also reiterate that this integrated model could also be extended to other advanced chronic diseases, including chronic heart, kidney and lung disease. With a rapidly aging population and therefore an increased burden of serious illnesses, more than 13.7 million people in the U.S. could benefit from palliative care. The PAL LIVER trial lays the foundation to meet these growing needs.
About the study:
The trial was conducted at Jefferson Einstein Philadelphia Hospital and was funded by the Patient Centered Outcomes Research Institute. The multicenter trial included 19 academic medical centers (both Veterans Administration (VA) and non-VA medical centers). Part of the palliative care training program was funded by the Albert Einstein Society . The study is registered at ClinicalTrials.gov (NCT03540771).
Media Contact: Deborah Balthazar, 267-254-9851, deborah.balthazar@jefferson.edu
About Jefferson
Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and eastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 33 hospital campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 40 years.
JAMA Internal Medicine
10.1001/jamainternmed.2026.0571
Randomized controlled/clinical trial
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