Hospice care for end stage liver disease in the United States

Orman, Eric S.; Johnson, Amy W.; Ghabril, Marwan; Sachs, Greg A.

doi:10.1080/17474124.2021.1892487

Cited by 4 publications

(8 citation statements)

References 148 publications

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“…Yet this scale also answers the call to use markers such as ascites, encephalopathy, and frailty to provide a more nuanced clinical risk assessment for mortality. 11,19 Patients with a MELD-Na ≥ 21 and any level of functional dependence will meet the criteria for hospice discussion by the HELP scale which underscores the importance of functional status, even in the absence of major complications of portal hypertension for patients with a high MELD-Na score. The HELP scale also demonstrates that a MELD-Na ≥ 21 with only 1 listed complication of portal hypertension does not meet the threshold for opening a hospice discussion but the cumulative effect or two or more listed complications will generally meet the threshold of 28 and may serve as a trigger to providers to begin discussions regarding the utility of hospice referral.…”

Section: Discussionmentioning

confidence: 99%

“…7,9,10 The benefits of hospice in the EOL management of patients with ESLD is poorly understood because it is currently underutilized. 11,12 ESLD does not fall within the top 15 principal diagnoses for hospice enrollment in Medicare decedents despite being the 11th leading cause of death in the United States. 13,14 Yet advanced cancer has demonstrated significant benefits using hospice to improve QOL during terminal illness and early data suggests that patients with chronic end-organ illnesses such as ESLD may also confer similar benefits.…”

Section: Introductionmentioning

confidence: 98%

“…Maintaining patient‐centered QOL in hospice management allows emphasis on domains of supportive care which are often lacking in the traditional EOL management of patients with ESLD 7,9,10 . The benefits of hospice in the EOL management of patients with ESLD is poorly understood because it is currently underutilized 11,12 . ESLD does not fall within the top 15 principal diagnoses for hospice enrollment in Medicare decedents despite being the 11th leading cause of death in the United States 13,14 .…”

Section: Introductionmentioning

confidence: 99%

“…Physicians and patients may be uncomfortable delving into conversations regarding mortality and EOL based solely on lab values. A recent expert opinion regarding hospice care for ESLD in the United States concluded that the limitations of established prognostic measures, including MELD‐Na, signify a need for a new approach to data‐driven hospice criteria to assist the patient and provider in considering hospice referral despite the uncertain course of advanced liver disease 11 …”

Section: Introductionmentioning

confidence: 99%

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Consider hospice in end‐stage liver disease prognostic scale to open discussions regarding six‐month mortality

2023

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Background and Aim Hospice is underutilized in the management of patients with end‐stage liver disease and may improve the patient experience at the end of life. This study aims to create a novel prognostic scale to accurately predict 6‐month mortality to more comprehensively facilitate hospice referral. Methods Sociodemographic, clinical, and laboratory variables associated with mortality from the United Network for Organ Sharing database were tested in univariate analysis followed by multivariate analyses with four predictor groups: Demographics, Diagnoses, Complexities, and Laboratory studies to develop the hospice in end‐stage liver disease prognostic scale (HELP) scale (70% sample, N = 13 516) followed with replication in a 30% (N = 5792) internal validation sample. Results Only the predictor groups of Complexities and Laboratory studies met the c‐statistic threshold of 0.70 for inclusion in the multivariate analyses. Backward elimination in the final logistic regression and validated weighted transformation procedure resulted in: HELP scale = (functional status × 11) + (ascites × 3) + (SBP × 3) + (HE × 4) + (dialysis × 5) + (TIPS × −3) + (albumin × −3) + (MELD‐Na ≥ 21 × 20). HELP scale had a strong predictive value for six‐month mortality with Area under the Receiver Operating Curve (AUROC) 0.816 and replicated in the validation sample. Conclusion HELP scale is a novel prognostic score utilizing the strength of model of end‐stage liver disease‐sodium (MELD‐Na), along with clinical factors, for a more nuanced assessment of six‐month mortality. This scale can provide an individualized approach in opening discussions of hospice referral and may be better accepted by patients and providers given its contextualization of important clinical factors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Consider hospice in end‐stage liver disease prognostic scale to open discussions regarding six‐month mortality

2023

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“… 3 Patients are identified to be at the terminal stage if they have an estimated survival of 6 months or less. 4 Palliative care is an interdisciplinary approach, defined as care that provides relief from pain and other symptoms and supports quality of life for patients with serious advanced illness and their families. 5 According to the WHO, more than 56.8 million people worldwide are in need of palliative care each year, including 25.7 million in the last year of their lives.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of virtual reality technology in symptom management of end-of-life patients: protocol of a systematic review and meta-analysis

et al. 2023

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IntroductionWith the worsening of population ageing globally, the number of the elderly with chronic and incurable diseases such as malignant tumours is gradually increasing, and the need for palliative care is growing. As a primary task in the end-of-life phase, symptom management is an essential aspect of palliative care, which aims to alleviate distressing symptoms of terminally ill patients and improve their quality of life. Virtual reality (VR) technology, which allows the creation of simulated environments in which a three-dimensional experience is generated, has been increasingly used in palliative care for symptom management. Therefore, we aim to conduct a systematic review to investigate the effects of VR-based interventions on end-of-life patients.Methods and analysisThis protocol for conducting a systematic review and meta-analysis will be prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. We will conduct a series of searches from inception to 31 July 2022 in the following databases: PubMed, Embase, Web of Science, the Cochrane Library, JBI, EBSCO, CNKI, Wanfang and SinoMed. The key concepts of ‘virtual reality’ and ‘end-of-life’ will be combined in each database using both free-text terms and controlled vocabulary terms (eg, MeSH/Emtree terms), if available. Two independent reviewers will use raw data to explore the effectiveness of VR for symptom management in end-of-life patients. The Cochrane Risk-of-Bias tool will be used to assess the risk of bias of included studies. Disagreements will be resolved by a third independent reviewer to reach a consensus. For the included articles, Review Manager software will be used for data synthesis and I2statistics will be used to measure the heterogeneity. Subgroup analyses and sensitivity analyses will be used to identify the source of heterogeneity.Ethics and disseminationAs this is a protocol for a systematic review and meta-analysis, patients will not be included in this study. For this reason, ethical approval is not required. In order to disseminate the research findings, the results and conclusions of this review will be submitted to a worldwide journal.PROSPERO registration numberCRD42022344679.

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What Are the Causes and Complications of Chronic Liver Disease and What Is the Evidence for Palliative Care Delivery to Those Affected by It?

Patel,

Ufere,

Rakoski

et al. 2023

Evidence-Based Practice of Palliative Medicine

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Hospice care for end stage liver disease in the United States

Cited by 4 publications

References 148 publications

Consider hospice in end‐stage liver disease prognostic scale to open discussions regarding six‐month mortality

Consider hospice in end‐stage liver disease prognostic scale to open discussions regarding six‐month mortality

Effectiveness of virtual reality technology in symptom management of end-of-life patients: protocol of a systematic review and meta-analysis

What Are the Causes and Complications of Chronic Liver Disease and What Is the Evidence for Palliative Care Delivery to Those Affected by It?

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