Integrative Review of Co‐Occurring Symptoms Across Etiologies of Chronic Liver Disease and Implications for Symptom Management Research and Practice

An, Kyungeh; Jallo, Nancy; Menzies, Victoria; Kinser, Patricia A.; Robins, Jo Lynne W.; Starkweather, Angela

doi:10.1111/jnu.12146

Cited by 15 publications

(14 citation statements)

References 39 publications

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“…Chronic liver disease (CLD) affects over 30 million people worldwide with a prevalence that is rising rapidly because of the ongoing impact of viral hepatitis and the rapidly rising impact of obesity‐related liver disease. CLD can originate from a wide range of aetiologies, including viral hepatitis, autoimmune liver disease (primary biliary cholangitis (PBC), autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC), nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH), alcoholic liver disease (ALD), as well as genetic conditions (hemochromatosis and alpha‐1‐antitrypsin deficiency) …”

Section: Introductionmentioning

confidence: 99%

“…CLD can originate from a wide range of aetiologies, including viral hepatitis, autoimmune liver disease (primary biliary cholangitis (PBC), autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC), nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH), alcoholic liver disease (ALD), as well as genetic conditions (hemochromatosis and alpha-1-antitrypsin deficiency). 1 The prevalence of NAFLD in the general population is approximately 20%-30% in Western countries, and 5%-18% in Asia. 2 NAFLD consists of a spectrum of liver conditions ranging from the simple deposition of fat in the liver (steatosis; termed nonalcoholic fatty liver or NAFL), to steatosis with associated hepatocyte injury (NASH).…”

Section: Introductionmentioning

confidence: 99%

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Fatigue in chronic liver disease: New insights and therapeutic approaches

Swain

Jones

2018

Liver International

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The management of fatigue associated with chronic liver disease is a complex and major clinical challenge. Although fatigue can complicate many chronic diseases, it is particularly common in diseases with an inflammatory component. Fatigue can have both peripheral (i.e., neuromuscular) and central (i.e., resulting from changes in neurotransmission within the brain) causes. However, fatigue in chronic liver disease has strong social/contextual components and is often associated with behavioural alterations including depression and anxiety. Given the increasing awareness of patient-reported outcomes as important components of treatment outcomes and clinical research, there is a growing need to better understand and manage this poorly understood yet debilitating symptom. Although several pathophysiological mechanisms for explaining the development of fatigue have been generated, our understanding of fatigue in patients with chronic liver disease remains incomplete. A better understanding of the pathways and neurotransmitter systems involved may provide specific directed therapies. Currently, the management of fatigue in chronic liver disease can involve a combined use of methods to beneficially alter behavioural components and pharmacological interventions, of which several treatments have potential for the improved management of fatigue in chronic liver disease. However, evidence and consensus are lacking on the best approach and the most appropriate biochemical target(s) whilst clinical trials to address this issue have been few and limited by small sample size. In this review, we outline current understanding of the impact of fatigue and related symptoms in chronic liver disease, discuss theories of pathogenesis, and examine current and emerging approaches to its treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fatigue in chronic liver disease: New insights and therapeutic approaches

Swain

Jones

2018

Liver International

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“…(22) Fatigue, weakness, pain, and lack of energy have been identified as the symptoms most commonly experienced by patients with chronic liver disease. (56)(57)(58) While expertise in symptom management for other diseases has advanced, the selection of appropriate medication and dosing for patients with ESLD is often more difficult due to a lack of evidence-based literature. Suggested treatments and preventative strategies for the management of the commonest complications of ESLD are illustrated in Table 2.…”

Section: Quality Of Life and Palliative Managementmentioning

confidence: 99%

Palliative care in end‐stage liver disease: Time to do better?

et al. 2018

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Optimal involvement of palliative care (PC) services in the management of patients with decompensated cirrhosis and end-stage liver disease (ESLD) is limited. This may result from both ignorance and the failure to recognize the spectrum and unpredictability of the underlying liver condition. Palliative care is a branch of medicine that focuses on quality of life (QoL) by optimizing symptom management and providing psychosocial, spiritual, and practical support for both patients and their caregivers. Historically, palliative care has been underutilized for patients with decompensated liver disease. This review provides an evidence-based analysis of the benefits of the integration of palliative care into the management of patients with ESLD. Liver Transplantation 24 961-968 2018 AASLD.

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“…An often asymptomatic early phase is typically followed by the progressive development of disease‐related symptoms which can have a significant impact on life quality . Typical PBC‐related symptoms include fatigue, pruritus, dry eyes and mouth, and occasional abdominal and bone pain . Fatigue can be profound and persistent, and is typically unrelated to histological stage or activity of the disease …”

Section: Introductionmentioning

confidence: 99%

“…1,2 Typical PBC-related symptoms include fatigue, pruritus, dry eyes and mouth, and occasional abdominal and bone pain. 3,4 Fatigue can be profound and persistent, and is typically unrelated to histological stage or activity of the disease. [5][6][7] Recent years have seen significant evolution in the treatment of PBC.…”

Section: Introductionmentioning

confidence: 99%

PBC‐10: a short quality of life measure for clinical screening in primary biliary cholangitis

Alrubaiy

Mells

Flack

et al. 2019

Aliment Pharmacol Ther

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Summary Background Current guidelines in primary biliary cholangitis ( PBC) recommend routine screening for symptoms. However, at present there are no validated practical tools suitable for screening use in practice. Aim To develop a short quality of life questionnaire for PBC Methods The short PBC HRQL questionnaire was derived and validated by analysing the PBC‐40 questionnaires from the UK‐PBC Research Cohort. Construct validity was assessed using the European Quality of Life Five Dimensions (EQ5D) questionnaire. Test‐retest analysis was done by asking a subgroup of patients to complete the questionnaire twice within 2‐4 weeks. Results A total of 2219 patients completed PBC‐40 questionnaire in 2013. Stepwise regression identified 10 questions that contributed to more than 95% of the PBC‐40 score variance and covered the main domains of PBC. The short HRQL questionnaire, PBC‐10, had good internal consistency (Cronbach's α 0.905) and item‐total correlations. PBC‐10 demonstrated no ceiling effects but a floor effect was noted. Further validation on 2502 patients who completed the PBC questionnaire in 2017 confirmed the psychometric properties of PBC‐10. Further analysis on 186 patients showed that PBC‐10 demonstrated good internal consistency (Cronbach's α = 0.936), had good reproducibility (intra‐class correlation coefficient = 0.945), good correlation with the EQ5D (r = .736), and was responsive to change. A change of 4 points in the PBC‐10 score would be considered clinically important. Conclusion PBC‐10 is a short and valid questionnaire for assessing the HRQL in patients with PBC in clinical practice.

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Integrative Review of Co‐Occurring Symptoms Across Etiologies of Chronic Liver Disease and Implications for Symptom Management Research and Practice

Abstract: Nurses play an important role in symptom assessment and may use the findings from the integrative review to incorporate core symptom measures across chronic liver disease populations and advance the development and delivery of symptom management interventions.

Cited by 15 publications

References 39 publications

Fatigue in chronic liver disease: New insights and therapeutic approaches

Fatigue in chronic liver disease: New insights and therapeutic approaches

Palliative care in end‐stage liver disease: Time to do better?

PBC‐10: a short quality of life measure for clinical screening in primary biliary cholangitis

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