Palliative Care in Terminally Ill Advanced Chronic Liver Disease Patients

Overview

Journal Wien Klin Wochenschr

Publisher Springer

Specialty General Medicine

Date 2024 Sep 10

PMID 39254776

Authors

Katharina Pomej

Eva Katharina Masel

Gudrun Kreye

Affiliations

Soon will be listed here.

Abstract

While mortality rates from advanced chronic liver disease (ACLD) are rapidly increasing, patients with an advanced disease stage have a comparable or even higher symptom burden than those with other life-limiting diseases. Although evidence is limited there is increasing recognition of the need to improve care for patients with ACLD; however, there are many limiting factors to providing good palliative care for these patients, including unpredictable disease progression, the misconception of palliative care and end of life care as being equivalent, a lack of confidence in prescribing medication and a lack of time and resources. Health professionals working with these patients need to develop the skills to ensure effective palliative care, while referral to specialized palliative care centers should be reserved for patients with complex needs. Basic palliative care, along with active disease management, is best delivered by the treating hepatologists. This includes discussions about disease progression and advance care planning, alongside the active management of disease complications. Liver disease is closely associated with significant social, psychological, and financial burdens for patients and their caregivers. Strategies to engage the discussion in multidisciplinary teams early in disease progression help to ensure addressing these issues proactively. This review summarizes the evidence on palliative care for patients with ACLD, provides examples of current best practice and offers suggestions on how disease-modifying and palliative care can coexist, to ensure that patients do not miss opportunities for quality of life improving interventions.

References

Williams R, Aspinall R, Bellis M, Camps-Walsh G, Cramp M, Dhawan A . Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet. 2014; 384(9958):1953-97. DOI: 10.1016/S0140-6736(14)61838-9. View

Strand J, Mansel J, Swetz K . The growth of palliative care. Minn Med. 2014; 97(6):39-43. View

DAmico G, Garcia-Tsao G, Pagliaro L . Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2005; 44(1):217-31. DOI: 10.1016/j.jhep.2005.10.013. View

Woodland H, Hudson B, Forbes K, McCune A, Wright M . Palliative care in liver disease: what does good look like?. Frontline Gastroenterol. 2020; 11(3):218-227. PMC: 7223359. DOI: 10.1136/flgastro-2019-101180. View

Moreau R, Delegue P, Pessione F, Hillaire S, Durand F, Lebrec D . Clinical characteristics and outcome of patients with cirrhosis and refractory ascites. Liver Int. 2004; 24(5):457-64. DOI: 10.1111/j.1478-3231.2004.0991.x. View

Medici V, Rossaro L, Wegelin J, Kamboj A, Nakai J, Fisher K . The utility of the model for end-stage liver disease score: a reliable guide for liver transplant candidacy and, for select patients, simultaneous hospice referral. Liver Transpl. 2008; 14(8):1100-6. DOI: 10.1002/lt.21398. View

Kanwal F, Hernaez R, Liu Y, Taylor T, Rana A, Kramer J . Factors Associated With Access to and Receipt of Liver Transplantation in Veterans With End-stage Liver Disease. JAMA Intern Med. 2021; 181(7):949-959. PMC: 8145153. DOI: 10.1001/jamainternmed.2021.2051. View

Ubhi N, Mourad A, Tausan M, Lewis D, Smethurst J, Wenlock R . Outcomes after hospitalisation with spontaneous bacterial peritonitis over a 13-year period: a retrospective cohort study. Eur J Gastroenterol Hepatol. 2023; 35(4):384-393. DOI: 10.1097/MEG.0000000000002524. View

Poonja Z, Brisebois A, Veldhuyzen Van Zanten S, Tandon P, Meeberg G, Karvellas C . Patients with cirrhosis and denied liver transplants rarely receive adequate palliative care or appropriate management. Clin Gastroenterol Hepatol. 2013; 12(4):692-8. DOI: 10.1016/j.cgh.2013.08.027. View

10.

Patel A, Walling A, Ricks-Oddie J, May F, Saab S, Wenger N . Palliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life. Clin Gastroenterol Hepatol. 2017; 15(10):1612-1619.e4. PMC: 5544588. DOI: 10.1016/j.cgh.2017.01.030. View

11.

Holden J, Shamseddeen H, Johnson A, Byriel B, Subramoney K, Cheng Y . Palliative Care and Hospice Referrals in Patients with Decompensated Cirrhosis: What Factors Are Important?. J Palliat Med. 2020; 23(8):1066-1075. PMC: 7404816. DOI: 10.1089/jpm.2019.0501. View

12.

Ufere N, Halford J, Caldwell J, Jang M, Bhatt S, Donlan J . Health Care Utilization and End-of-Life Care Outcomes for Patients With Decompensated Cirrhosis Based on Transplant Candidacy. J Pain Symptom Manage. 2019; 59(3):590-598. PMC: 7024665. DOI: 10.1016/j.jpainsymman.2019.10.016. View

13.

Verma S, Verne J, Ufere N . Palliative care in advanced liver disease: time for action. Lancet Gastroenterol Hepatol. 2023; 8(2):106-108. DOI: 10.1016/S2468-1253(22)00382-X. View

14.

Williams R, Alexander G, Aspinall R, Bosanquet J, Camps-Walsh G, Cramp M . New metrics for the Lancet Standing Commission on Liver Disease in the UK. Lancet. 2016; 389(10083):2053-2080. DOI: 10.1016/S0140-6736(16)32234-6. View

15.

Ufere N, Donlan J, Waldman L, Dienstag J, Friedman L, Corey K . Barriers to Use of Palliative Care and Advance Care Planning Discussions for Patients With End-Stage Liver Disease. Clin Gastroenterol Hepatol. 2019; 17(12):2592-2599. PMC: 6745282. DOI: 10.1016/j.cgh.2019.03.022. View

16.

Karlsen T, Sheron N, Zelber-Sagi S, Carrieri P, Dusheiko G, Bugianesi E . The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet. 2021; 399(10319):61-116. DOI: 10.1016/S0140-6736(21)01701-3. View

17.

Verma S, Hingwala J, Low J, Patel A, Verma M, Bremner S . Palliative clinical trials in advanced chronic liver disease: Challenges and opportunities. J Hepatol. 2023; 79(5):1236-1253. DOI: 10.1016/j.jhep.2023.06.018. View

18.

Rogal S, Hansen L, Patel A, Ufere N, Verma M, Woodrell C . AASLD Practice Guidance: Palliative care and symptom-based management in decompensated cirrhosis. Hepatology. 2022; 76(3):819-853. PMC: 9942270. DOI: 10.1002/hep.32378. View

19.

Aithal G, Palaniyappan N, China L, Harmala S, Macken L, Ryan J . Guidelines on the management of ascites in cirrhosis. Gut. 2020; 70(1):9-29. PMC: 7788190. DOI: 10.1136/gutjnl-2020-321790. View

20.

Roth K, Lynn J, Zhong Z, Borum M, Dawson N . Dying with end stage liver disease with cirrhosis: insights from SUPPORT. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc. 2000; 48(S1):S122-30. View