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<h3>Background</h3> Advanced chronic liver disease is the second leading cause of premature mortality in the UK, associated with significant symptom burden, poor health-related quality of life, and frequent hospital admissions in the last years of life. The clinical complexity of this cohort, coupled with prognostic uncertainty, can contribute to the unmet need of these patients. The EVOLVE study concluded that documentation of prognosis and advanced care planning (ACP) was limited, calling for immediate action to address such inequalities. <h3>Project Aims</h3> 1. Review the ACP in end-stage liver disease within a tertiary liver unit. 2. Develop a liver-specific ACP tool. <h3>Methods</h3> 1. Prospective notes audit reviewing admission rates, indications and ACP documentation for all inpatients with a diagnosis of chronic liver disease not suitable for transplantation. 2. In conjunction with the liver team, to develop an ACP tool exploring predictable decompensation complications and management options. <h3>Results</h3> The 33 eligible patients had totalled 728 inpatient bed days in the prior year, with 66 admissions for decompensation episodes. 85% had a ReSPECT form in place, 50% of these were for full escalation. Two ReSPECT forms documented specific wishes in the event of decompensation. Seven weeks post audit, 24% patients had subsequently died, 37.5% of whom were for full escalation when audited. <h3>Conclusion</h3> Appropriate ACP discussions are not being achieved within this defined cohort, nor do they cover specifics around predictable complications they are likely to encounter. A booklet is in development which will provide information around the four main complications (ascites, encephalopathy, variceal bleeds, hepatocellular carcinoma), discussing potential management options and providing white space questions to enable patients to document their wishes. This ACP document is the first of its kind for this defined cohort where there is huge unmet need in relation to end of life care.