How Do Patients With Cirrhosis and Their Caregivers Learn About and Manage Their Health? A Review and Qualitative Study

Abstract

The complexity of cirrhosis requires patients and their caregivers to be well educated to improve outcomes. Data are lacking regarding how to best educate patients and their caregivers in the setting of cirrhosis. Our aim is to understand (both through existing literature and by asking patients and their caregivers) how patients learn about their disease, barriers in their education and disease management, and self‐management strategies. We performed a structured search of published articles in PubMed (1973 to 2020) using keywords “cirrhosis” plus “barriers”, “education”, “self‐management”, or “self‐care”. Additionally, we conducted a focus group of a representative sample of patients and their caregivers to understand how knowledge about cirrhosis is found and incorporated into self‐management. Of 504 returned manuscripts, 11 pertained to barriers in cirrhosis, interventions, or educational management. Barriers are well documented and include disease complexity, medication challenges, comorbid conditions, and lack of effective education. However, data regarding addressing these barriers, especially effective educational interventions, are scarce. Current strategies include booklets and videos, patient empowerment, and in‐person lectures. Without widespread use of these interventions, patients are left with suboptimal knowledge about their disease, a sentiment unanimously echoed by our focus group. Despite linkage to subspecialty care and consistent follow‐up, patients remain uncertain about their disease origin, prognosis, and therapies to manage symptoms. It is clear that more data are needed to assess effective strategies to address unmet educational needs. Existing strategies need to be blended and improved, their effectiveness evaluated, and the results distributed widely.

The emotional burden of caregiving for patients with cirrhosis

“…Nutrition is another factor associated with caregiver burden—balancing addressing frailty while adhering to dietary restrictions. Education, especially in this domain, is desired by caregivers, [ 24 ] and its ongoing improvement would be beneficial. Although increasingly common, cirrhosis is rare enough and beset by stigma such that sustainable support groups (online and in person) are lacking.…”

Patient‐oriented medication education intervention has long‐term benefits for people with decompensated cirrhosis

“…To the editor, Patient barriers to self-management in cirrhosis are complex. [1] Although several studies have demonstrated improved knowledge or self-care behaviors following education, [1] long-term outcome data are lacking. We previously reported that a multifaceted pharmacist-led intervention for people with decompensated cirrhosis (including patient-oriented education, medication reconciliation, and identification and resolution of "highrisk" medication-related problems) was associated with fewer unplanned admissions at 12 months compared to usual care (adjusted incidence rate ratio [aIRR], 0.52; 95% confidence interval [CI], 0.30-0.92; p = 0.025).…”

Nurse-assisted and multidisciplinary outpatient follow-up among patients with decompensated liver cirrhosis: A systematic review

“…Lifestyle changes and self-care are essential to disease management. Still, low compliance with prevention and treatment recommendations and inadequate self-care among patients with liver cirrhosis often leads to worse outcomes [14][15][16].…”