Attitudes of Liver and Palliative Care Clinicians toward Specialist Palliative Care Consultation for Patients with End-Stage Liver Disease

Esteban, James; Rein, Lisa; Szabo, Aniko; Saeian, Kia; Rhodes, Mary; Marks, Sean

doi:10.1089/jpm.2018.0553

Cited by 29 publications

(28 citation statements)

References 43 publications

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“…A majority of hepatologists believe that patients on the transplant wait list should be “full code”; they report more discomfort with including PC services in discussions about prognosis and ACP documentation when patients are transplant eligible compared to ineligible patients. ( 78 , 79 ) Lower levels of comfort with performing ACP and managing expectations, lack of continuity of care, and misperceptions about PC services all contribute to low rates of ACP. ( 28 , 80 , 81 ) For instance, in one single‐center study, an overwhelming majority of attending transplant hepatologists misperceived PC as being synonymous with end‐of‐life care.…”

Section: Resultsmentioning

confidence: 99%

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

et al. 2021

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Individuals with advanced liver disease (AdvLD), such as decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC), have significant palliative needs. However, little research is available to guide health care providers on how to improve key domains related to palliative care (PC). We sought to identify priority areas for future research in PC by performing a comprehensive literature review and conducting iterative expert panel discussions. We conducted a literature review using search terms related to AdvLD and key PC domains. Individual reviews of these domains were performed, followed by iterative discussions by a panel consisting of experts from multiple disciplines, including hepatology, specialty PC, and nursing. Based on these discussions, priority areas for research were identified. We identified critical gaps in the available research related to PC and AdvLD. We developed and shared five key priority questions incorporating domains related to PC. Conclusion: Future research endeavors focused on improving PC in AdvLD should consider addressing the five key priorities areas identified from literature reviews and expert panel discussions. (Hepatology Communications 2021;0:1-12).

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Section: Resultsmentioning

confidence: 99%

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

et al. 2021

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“…Concerns are often raised about metabolism and side effects of drugs, especially analgesics, in ESLD25 and advice regarding safe dosages is typically vague, encouraging caution. Despite a high pain and symptom burden, inadequate analgesic use is often reported by this group 67 68.…”

Section: Pc In Esld: What Work?mentioning

confidence: 99%

“…The onset of hepatic encephalopathy (HE) can also leave patients lacking capacity and unable to participate in ACP discussions 24. Two recent surveys of gastroenterologists, hepatologists and SPC physicians identified multiple concerns, including unclear criteria for SPC referral, discomfort with the role of SPC physicians in joint care, the belief PC is synonymous with EOL care, insufficient time to engage in complex discussions and uncertainty about appropriate medication for symptom control 25 26. Despite this, the vast majority of gastroenterology and hepatology specialists (86%) recognised patients with ESLD benefit from earlier PC input and also felt initial discussions regarding ACP should be initiated by themselves, as the responsible clinician, rather than by SPC physicians 26…”

Section: Introductionmentioning

confidence: 99%

“…The perception that PC is mutually exclusive to disease modifying treatments and transplantation has been recognised as a key barrier in the timely initiation of core PC measures 11 25. Although liver transplantation offers a potential cure, approximately 1000 transplants are carried out in the UK each year, while several thousand patients die from CLD annually.…”

Section: Introductionmentioning

confidence: 99%

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Palliative care in liver disease: what does good look like?

Woodland

Hudson

Forbes

et al. 2019

Frontline Gastroenterol

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The mortality rate from chronic liver disease in the UK is rising rapidly, and patients with advanced disease have a symptom burden comparable to or higher than that experienced in other life-limiting illnesses. While evidence is limited, there is growing recognition that care of patients with advanced disease needs to improve. Many factors limit widespread provision of good palliative care to these patients, including the unpredictable trajectory of chronic liver disease, the misconception that palliative care and end-of-life care are synonymous, lack of confidence in prescribing and lack of time and resources. Healthcare professionals managing these patients need to develop the skills to ensure effective delivery of core palliative care, with referral to specialist palliative care services reserved for those with complex needs. Core palliative care is best delivered by the hepatology team in parallel with active disease management. This includes ensuring that discussions about disease trajectory and advance care planning occur alongside active management of disease complications. Liver disease is strongly associated with significant social, psychological and financial hardships for patients and their carers; strategies that involve the wider multidisciplinary team at an early stage in the disease trajectory help ensure proactive management of such issues. This review summarises the evidence supporting palliative care for patients with advanced chronic liver disease, presents examples of current best practice and provides pragmatic suggestions for how palliative and disease-modifying care can be run in parallel, such that patients do not miss opportunities for interventions that improve their quality of life.

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“…This was consistent with a further U.S. survey conducted by Esteban et al in 2019. 48 The survey found that palliative care referrals were often not made due to perceptions that it was too early in the patients' disease trajectory, would influence liver transplant eligibility, unavailability of palliative care specialists, and the perceived lack of palliative care needs. Studies of patient and carer perspectives on palliative care also consider barriers to palliative care.…”

Section: Current Barriers To Accessing Palliative Carementioning

confidence: 99%

Emerging Role of Palliative Care in Patients with Advanced Liver Disease

Jordan

Tandon

2019

Semin Liver Dis

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Advanced liver disease is increasing in mortality and morbidity worldwide, as a result of growing alcohol consumption, obesity, and viral hepatitis infection. Alongside efforts to reduce these factors, it is clear that we must identify the considerable palliative care needs of these patients in order to improve quality of life and reduce symptom burden. Our review focuses on the current state of palliative and end-of-life care for patients with advanced liver disease, the significant associated symptom burden in this disease group, identified level of involvement and potential benefits of specialist palliative care, as well as possible barriers to accessing this care. We demonstrate that although palliative care involvement varies considerably worldwide, there is much opportunity for improvement. Further research is needed to determine new interventions and models of care that may improve access for patients with liver disease, including an expansion of providers comfortable with generalist palliative care.

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Attitudes of Liver and Palliative Care Clinicians toward Specialist Palliative Care Consultation for Patients with End-Stage Liver Disease

Cited by 29 publications

References 43 publications

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach

Palliative care in liver disease: what does good look like?

Emerging Role of Palliative Care in Patients with Advanced Liver Disease

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