Frequently patients with advanced liver disease experience physical and emotional symptoms during their hospitalization that can may cause a level of discomfort to both the patient and the family members that surround them.

This study involves the early introduction of a team of clinicians that specialize in the lessening (palliation) of many of these discomforting symptoms. This team of clinicians is called the palliative care team and they focus on ways to improve pain and other symptom management and to assist patients and their families in coping with the physical, emotional and social issues associated with a diagnosis of advanced liver disease. The team consists of physicians and advance practice nurses who have been specially trained in the care of patients facing serious illness and their caregivers.

The investigators are studying the feasibility of delivering this program, the acceptability and satisfaction with the program, and changes in the quality of life, illness understanding, and symptoms of hospitalized patients who receive the program and their caregivers. The study will use a series of questionnaires to measure the study participants' quality of life, physical symptoms, illness and prognostic understanding, and mood. Study questionnaires will be completed in the hospital, home or clinic. Qualitative interviews will be conducted with hepatology and palliative care clinicians as well as patients and caregivers.

Patient Inclusion Criteria:

1. Adult (≥ 18 years old) with advanced liver disease defined as cirrhosis complicated by one of the following (new or ongoing) clinically-evidence decompensating events

   1. Ascites (requiring diuretics or large volume paracenteses)
   2. Hepatic encephalopathy (requiring medical therapy)
   3. History of variceal bleed episode within 1 year of enrollment

2. Admitted to the general medicine service

3. Ability fo communicate in English and provide informed consent

4. Have a score ≥ 7 on the Short Portable Mental Status Questionnaire

Patient Exclusion Criteria:

1. Patients with severe hepatic encephalopathy or any other comorbid condition which the primary medical team believes prohibits compliance with study procedures
2. Patients with advanced malignancies being treated with palliative intent
3. Patients already receiving specialty palliative care and/or hospice care

Caregiver Eligibility Criteria

1. A relative or friend of eligible patient, who lives with them and has in-person contact with them at least twice per week
2. Verbally fluent in English or able to complete questionnaires with the help of an interpreter
3. Age 18 or older

Clinician Selection: All palliative care clinicians who deliver the LiverPal intervention will participate in qualitative interviews. Inpatient clinicians who provided direct care to enrolled patients in either the inpatient or outpatient setting will also be eligible to participate in the qualitative interviews.