Advance Care Planning for Patients with Cirrhosis in a Structured Inpatient/Outpatient Hepatology Program

Najafian, Nilofar; Sack, Jordan; DeLisle, Angela; Jakab, Simona

doi:10.1089/jpm.2018.0261

Cited by 20 publications

(33 citation statements)

References 9 publications

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“…( 59 ) The fact that few patients have advance directives or any conversation with providers regarding goals of care (GOC) makes it largely unclear whether the care they receive throughout their disease trajectory or at the end of life is concordant with their goals. ( 29 , 50 , 74 , 75 )…”

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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“…These rates of advance directive completion are much lower compared to the national average; approximately 40% of patients with chronic illnesses have completed a living will, health care power of attorney, or both [21]. Similar findings have been reported among transplant-ineligible patients with advanced liver disease; in one retrospective study, 0% of transplant-ineligible patients had ACP discussions documented in their medical charts during their outpatient hepatology clinic visits [22]. In another series, only 28% of patients with cirrhosis who were delisted for liver transplantation had a "do not resuscitate" designation in their medical chart [14].…”

Section: Current State Of Acp In Advanced Liver Diseasementioning

confidence: 67%

Advance Care Planning and Goals of Care Discussions in Advanced Liver Disease

Ufere

2021

Curr Hepatology Rep

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Purpose of Review Advance care planning (ACP) has been shown to improve multiple outcomes in patients with serious illnesses; however, patients with advanced liver disease, or cirrhosis, rarely receive timely ACP. The purpose of this review is to evaluate the current state of ACP for patients with advanced liver disease and to provide practical guidance for integrating early ACP into routine outpatient hepatology care. Recent Findings Due to multiple patient-, physician-, and systems-level barriers, patients with advanced liver disease have low rates of timely ACP engagement. Early identification and preparation of a surrogate decision-maker, enhancing clinician ACP communication skills, use of patient-centered educational tools, optimizing outpatient processes for ACP documentation, and early referral to specialty palliative care may help to improve current deficits in ACP for this population. Summary Provision of early ACP to patients with advanced liver disease may better ensure that patients receive medical care that is consistent with their goals and values.

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“…Najafian et al found that none of the 58 nontransplant eligible end-stage liver disease patients seen in their transitional care liver clinic had advance care planning discussions despite further hospitalizations. 20 In the US, over 70% of deaths from liver disease occur in hospital. 7 Hudson et al conducted a national retrospective study of 13,818 people who died from liver disease in England (2013-2015), and had at least one large-volume paracentesis procedure in the last year of life.…”

Section: The Tremendous Symptom Burden Of Advanced Liver Diseasementioning

confidence: 99%

“…[39][40][41] Although randomized controlled trials have not been conducted to evaluate the effect of palliative care for patients with end-stage liver disease, several observational studies have reported potential benefits in patients with advanced liver disease who accessed palliative care compared to those who did not. 20,32,37,42,43 Baumann et al's longitudinal study of patients referred for liver transplant evaluation (2013-2014) who received an early palliative intervention showed improvement in both physical symptoms (50% improvement in moderate-to-severe symptoms) and depressive symptoms (43% of patients with improvement). 42 Patients with more symptoms had the greatest improvement in depressive symptoms with early palliative care.…”

Section: The Potential Benefits Of Palliative Carementioning

confidence: 99%

“…Najafian et al found that nontransplant eligible end-stage liver disease patients seen in their transitional care liver clinic after discharge from an inpatient liver unit were more likely to die out of hospital if they accessed palliative care. 20 Patel et al conducted an observational study of terminal hospitalizations of patients with decompensated cirrhosis (2009-2013). 32 They found that access to palliative care was associated with reduced procedure burden and costs of care.…”

Section: The Potential Benefits Of Palliative Carementioning

confidence: 99%

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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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Advance Care Planning for Patients with Cirrhosis in a Structured Inpatient/Outpatient Hepatology Program

Cited by 20 publications

References 9 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

Advance Care Planning and Goals of Care Discussions in Advanced Liver Disease

Emerging Role of Palliative Care in Patients with Advanced Liver Disease

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