This trial is comparing two ways of introducing palliative care for people with end stage liver disease - either by having direct access to a palliative care provider, or by training a hepatologist to deliver palliative care services. The primary outcome is the change in quality of life from baseline to 3 months post enrollment, as assessed by the Functional Assessment of Cancer Therapy- Hepatobiliary. 14 Clinical Centers across the US are recruited to participate in this study.