Emerging Role of Palliative Care in Patients with Advanced Liver Disease

Jordan, Roberta; Tandon, Puneeta

doi:10.1055/s-0039-3400259

Cited by 5 publications

(4 citation statements)

References 46 publications

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“…We also found that the LOS time trend per patient began to increase gradually after 2018. A possible reason for this is that, with improvement in national medical insurance policies and enhanced disease awareness among individuals, an increasing number of patients with severe liver disease (see Supplementary Figure S2A) choose to go to hospital, with a view to improving their quality of life and delaying progression of the disease through treatment (31,32). In our study, we compared medical expenditure time trends concerning patients with liver cirrhosis among various patient subgroups.…”

Section: Discussionmentioning

confidence: 99%

In-patient Expenditure Between 2012 and 2020 Concerning Patients With Liver Cirrhosis in Chongqing: A Hospital-Based Multicenter Retrospective Study

Tan¹,

Tang

He³

et al. 2022

Front. Public Health

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BackgroundLiver cirrhosis is a major global health and economic challenge, placing a heavy economic burden on patients, families, and society. This study aimed to investigate medical expenditure trends in patients with liver cirrhosis and assess the drivers for such medical expenditure among patients with liver cirrhosis.MethodsMedical expenditure data concerning patients with liver cirrhosis was collected in six tertiary hospitals in Chongqing, China, from 2012 to 2020. Trends in medical expenses over time and trends according to subgroups were described, and medical expenditure compositions were analyzed. A multiple linear regression model was constructed to evaluate the factors influencing medical expenditure. All expenditure data were reported in Chinese Yuan (CNY), based on the 2020 value, and adjusted using the year-specific health care consumer price index for Chongqing.ResultsMedical expenditure for 7,095 patients was assessed. The average medical expenditure per patient was 16,177 CNY. An upward trend in medical expenditure was observed in almost all patient subgroups. Drug expenses were the largest contributor to medical expenditure in 2020. A multiple linear regression model showed that insurance type, sex, age at diagnosis, marital status, length of stay, smoking status, drinking status, number of complications, autoimmune liver disease, and the age-adjusted Charlson comorbidity index score were significantly related to medical expenditure.ConclusionConservative estimates suggest that the medical expenditure of patients with liver cirrhosis increased significantly from 2012 to 2020. Therefore, it is necessary to formulate targeted measures to reduce the personal burden on patients with liver cirrhosis.

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Section: Discussionmentioning

confidence: 99%

In-patient Expenditure Between 2012 and 2020 Concerning Patients With Liver Cirrhosis in Chongqing: A Hospital-Based Multicenter Retrospective Study

Tan¹,

Tang

He³

et al. 2022

Front. Public Health

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“…Several studies within the past 5 years identified limited availability of PC services for patients with liver disease, leading to limited and late involvement of PC specialists, by which many potential benefits of PC may be lost. ( 10 ) In an analysis of a nationwide inpatient sample, Rush et al ( 11 ) found that only 4.5% of all ESLD‐related admissions received a PC consultation, although this increased from 1% in 2006 to 7.1% in 2012. Barnes et al ( 12 ) found that only 19% of eligible patients (defined as having ≥ 2 admissions within 6 months for decompensated cirrhosis, excluding those who were listed for liver transplantation [LT]) received “early PC” (i.e., as defined by, PC received > 30 days before death), with hospitalization costs significantly reduced in those with early PC because of a lower number of endoscopies and blood transfusions.…”

Section: Current State Of Pc For Esldmentioning

confidence: 99%

Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

2020

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Palliative care (PC) that has evolved from a focus on end-of-life care to an expanded form of holistic care at an early stage for patients with serious illnesses and their families is commonly referred to as nonhospice PC (or early PC). Patients with end-stage liver disease (ESLD) suffer from a high symptom burden and a deteriorated quality of life (QOL), with uncertain prognosis and limited treatment options. Caregivers of these patients also bear an emotional and physical burden similar to that of caregivers for patients with cancer. Despite the proven benefits of nonhospice PC for other serious illnesses and cancer, there are no evidence-based structures and processes to support its integration within the routine care of patients with ESLD and their caregivers. In this article, we review the current state of PC for ESLD and propose key structures and processes to integrate nonhospice PC within routine hepatology practice. Results found that PC is highly underutilized within ESLD care, and limited prospective studies are available to demonstrate methods to integrate PC within routine hepatology practices. Hepatology providers report lack of training to deliver PC along with no clear prognostic criteria on when to initiate PC. A well-informed model with key structures and processes for nonhospice PC integration would allow hepatology providers to improve clinical outcomes and QOL for patients with ESLD and reduce health care costs. Educating hepatology providers about PC principles and developing clear prognostic criteria for when and how to integrate PC on the basis of individual patient needs are the initial steps to inform the integration. The fields of nonhospice PC and hepatology have ample opportunities to partner clinically and academically. (Hepatology 2020;71:2149-2159). E nd-stage liver disease (ESLD) is the 12th leading cause of death and claims approximately 66,000 lives each year in the United States. (1) Between 2006 and 2016, the prevalence of ESLD increased by 7.9% among men 25-34 years of age and 11.4% among women in the same age group because of the increasing burden of nonalcoholic steatohepatitis, alcohol-associated liver disease, and advanced hepatitis C virus. (2) In parallel, mortality due to ESLD increased by 65% from 1999 to 2016. (3) ESLD is also associated with functional and cognitive impairment, often with concomitant mental health and substance use disorders. The physical and psychological symptom burden and social-role consequences of ESLD are often worse than those for many non-liver cancers. (4) The most frequently reported symptoms include pain, breathlessness, muscle cramps, sleep disturbance, fatigue, pruritus, anxiety, depression, and erectile dysfunction. (4) In addition to its direct effects on patients, ESLD is linked with a substantial caregiver emotional and physical burden, mirroring that observed in caregivers of patients with cancer. (5) However, interventions to improve the quality of life (QOL) for patients with ESLD and their caregivers are underdeveloped.Palliativ...

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“…Early integration of palliative care (PC) for patients with ESLD and their family caregivers is recommended, ( 7 , 8 , 9 , 10 ) yet remains underutilized. ( 11 , 12 , 13 , 14 , 15 ) One of the reasons for this is a limited specialty PC workforce.…”

mentioning

confidence: 99%

“…(3)(4)(5) These factors lead to significant deterioration in patients' quality of life with immense burden on caregivers. (6) Early integration of palliative care (PC) for patients with ESLD and their family caregivers is recommended, (7)(8)(9)(10) yet remains underutilized. (11)(12)(13)(14)(15) One of the reasons for this is a limited specialty PC workforce.…”

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confidence: 99%

Palliative Care Always: Hepatology—Virtual Primary Palliative Care Training for Hepatologists

et al. 2021

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Palliative care (PC) benefits patients with serious illness including end‐stage liver disease (ESLD). As part of a cluster randomized trial, hepatologists were trained to deliver primary palliative care to patients with ESLD using an online course, Palliative Care Always: Hepatology (PCA:Hep). Here we present a multimethod formative evaluation (feasibility, knowledge acquisition, self‐efficacy, and practice patterns) of PCA:Hep. Feasibility was measured by completion of coursework and achieving a course grade of >80%. Knowledge acquisition was measured through assessments before and throughout the course. Pre/post‐course surveys were conducted to determine self‐efficacy and practice patterns. The hepatologists (n = 39) enrolled in a 12‐week online course and spent 1‐3 hours on the course weekly. The course was determined to be feasible as 97% successfully completed the course and 100% passed. The course was acceptable to participants; 91.7 % reported a positive course experience and satisfaction with knowledge gained (91.6%). The pre/post knowledge assessment showed an improvement of 6.0% (pre 85.9% to post 91.9%, 95% CI [2.8, 9.2], P = 0.001). Self‐efficacy increased significantly (P < 0.001) in psychological symptom management, hospice, and psychosocial support. A year after training, over 80% of the hepatologists reported integrating a variety of PC skills into routine patient care. Conclusion: PCA:Hep is feasible, acceptable, and improves learner knowledge and confidence in palliative care skills. This is a viable method to teach primary PC skills to specialists caring for patients with ESLD.

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Emerging Role of Palliative Care in Patients with Advanced Liver Disease

Cited by 5 publications

References 46 publications

In-patient Expenditure Between 2012 and 2020 Concerning Patients With Liver Cirrhosis in Chongqing: A Hospital-Based Multicenter Retrospective Study

In-patient Expenditure Between 2012 and 2020 Concerning Patients With Liver Cirrhosis in Chongqing: A Hospital-Based Multicenter Retrospective Study

Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

Palliative Care Always: Hepatology—Virtual Primary Palliative Care Training for Hepatologists

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