Creating Effective Models for Delivering Palliative Care in Advanced Liver Disease

Abstract

Purpose of Review The current healthcare system is not fully equipped to provide comprehensive support for patients with advanced liver disease (ALD) and their caregivers resulting in concomitant suffering and reduced quality of life (QoL). Integration of palliative care (PC) within routine care has demonstrated benefits in improving symptoms and QoL and reducing healthcare utilization for other serious illnesses but has been underutilized or delayed for ALD care. The purpose of this article is to outline the domains and benefits of PC and discuss the misconceptions and barriers for PC integration, and healthcare delivery models supporting PC integration within ALD care. Recent Findings PC has eight key domains related to physical and mental health, goals for future care, and care of the caregivers. PC offers benefits to improve health outcomes and patient satisfaction and reduce healthcare utilization. To date there have been successful models of PC that are primarily hospital- or community-based; successful models have been PC specialist- or primary/generalist-led. Summary Concurrent PC within oncology has formed the basis for most evidence-based guidelines. PC integration within ALD care is still in its infancy. While amassing evidence in ALD, hepatology organizations can promote consensus-based integrated PC models that can guide research and practice efforts to increase supportive care for these patients in need and their family caregivers.

AASLD Practice Guidance: Palliative care and symptom‐based management in decompensated cirrhosis

“…[13,14] Although all eight domains can apply to patients with DC, their relative importance may vary across the illness trajectory. [5,15] Advance care planning (ACP) is a component of palliative care that involves the iterative and longitudinal process of medical decision making for patients and their families over the course of their illness trajectory. [16,17] ACP includes identifying surrogate decision makers, illness education and prognostic disclosure, and formal documentation of goals for medical and end-of-life care (EoLC) through advance directives that center on the goals, values, and preferences of patients and their families.…”

“…Offering trainees in hepatology the opportunity to serve on palliative care consultative services and in hospice settings may provide hands‐on experience and training that can diffuse into current hepatology practitioners. [ 5 ] Resources for further skill development are offered in Table .…”

“…For example, specialty palliative care providers can round on inpatient hepatology services or have colocated clinics with hepatology. [ 5 ] Alternatively, palliative care consultation can be automated based on trigger criteria (e.g., intensive care unit admission, removal from the transplant list). [ 88 ] Simply offering information about palliative care in hepatology settings can help caregivers and patients become more aware of their options.…”

“…[ 13,14 ] Although all eight domains can apply to patients with DC, their relative importance may vary across the illness trajectory. [ 5,15 ]…”

“…[1,2] The benefits of palliative care are increasingly recognized across disease states and for patients with decompensated cirrhosis (DC). [3][4][5] This American Association for the Study of Liver Diseases (AASLD) guidance to providing palliative care for patients with cirrhosis was developed with the support and oversight of the AASLD Practice Guidelines Committee. The AASLD Practice Guidelines Committee chose to commission a guidance, rather than a guideline, because of the paucity of randomized controlled trials (RCTs) on this topic.…”