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We read with interest the publication by Al-Moussally et al in the September issue of BMJ Supportive and Palliative Care titled ‘Palliative care in cirrhosis of the liver’.1 This valuable work highlighted the underutilisation of specialist palliative care services in patients with end-stage liver disease (ESLD) despite their high symptom burden. The authors highlighted referral barriers, including misperceptions of palliative care, as well as health resource factors and insurance coverage.