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

Mazzarelli, Chiara; Prentice, Wendy; Heneghan, Michael A.; Belli, Luca; Agarwal, Kosh; Cannon, Mary

doi:10.1002/lt.25193

Cited by 50 publications

(49 citation statements)

References 66 publications

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“…Decompensated liver cirrhosis and/ or liver cancer, collectively termed end-stage liver disease (ESLD) (1) are often the final stage of long-standing liver disease, and are responsible for a significant burden of morbidity and mortality worldwide. It is estimated that globally, over 1.2 million deaths in 2016…”

Section: Introductionmentioning

confidence: 99%

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index

Nartey

Awuku

Agyei-Nkansah

et al. 2020

Preprint

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Background: End-stage liver disease (ESLD) is a major burden on public health, particularly in sub-Saharan Africa, where hepatitis B virus (HBV) is an important risk factor. We aimed to describe clinical characteristics of ESLD from cirrhosis or hepatocellular carcinoma (HCC) and the performance of aspartate aminotransferase (AST) - platelet ratio index (APRI) and alpha fetoprotein (AFP) in Ghana. Methods: We performed an observational cross-sectional study in outpatient hepatology clinics at three teaching hospitals in Ghana, West Africa. One hundred and forty-one HCC, 216 cirrhosis and 218 chronic HBV patients were recruited by convenience sampling. Sociodemographic, history and examination, laboratory, and disease staging information were shown using descriptive statistics. Performance of the APRI score in diagnosis of cirrhosis and Alpha fetoprotein in the diagnosis of HCC was determined using AUROC analysis.Results: Median age at presentation was 44 years for HCC and 46 years for cirrhosis. HBV was found in 69.5% of HCC and 47.2% of cirrhosis cases, and HCV in 6.4% and 3.7% respectively. APRI cut-off of 2 had sensitivity of 45.4% and specificity of 95% in diagnosis of cirrhosis, and cut-off of 1 had sensitivity of 75.9% and specificity of 89%. AUC of AFP was 0.88 (95% CI 0.81-0.94) in diagnosis of HCC. Low monthly income was associated with lower odds of undertaking AFP. Thirty one percent of cirrhotic persons were Child-Pugh C, and 67.9% of HCC patients had advanced or terminal disease at presentation. Conclusions: Our findings emphasize the young age of ESLD patients in Ghana and the advanced nature at presentation. It highlights shortcomings in surveillance and the need for policies to address the burden and improve outcomes in Ghana.

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Section: Introductionmentioning

confidence: 99%

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index

Nartey

Awuku

Agyei-Nkansah

et al. 2020

Preprint

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“…The need for improvement in the care given to patients with ESLD towards the end of life (EOL) is increasingly recognised. Earlier institution of palliative care (PC) measures and advance care planning (ACP) discussions may allow patients and their carers to prepare better for disease progression and death 8–13. Unfortunately, changes in practice are slow, and many physicians will recognise the experience of Victoria Guy in 2006, as she witnessed her sister’s death from alcohol-related liver disease.…”

Section: Introductionmentioning

confidence: 99%

Palliative care in liver disease: what does good look like?

Woodland

Hudson

Forbes

et al. 2019

Frontline Gastroenterol

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The mortality rate from chronic liver disease in the UK is rising rapidly, and patients with advanced disease have a symptom burden comparable to or higher than that experienced in other life-limiting illnesses. While evidence is limited, there is growing recognition that care of patients with advanced disease needs to improve. Many factors limit widespread provision of good palliative care to these patients, including the unpredictable trajectory of chronic liver disease, the misconception that palliative care and end-of-life care are synonymous, lack of confidence in prescribing and lack of time and resources. Healthcare professionals managing these patients need to develop the skills to ensure effective delivery of core palliative care, with referral to specialist palliative care services reserved for those with complex needs. Core palliative care is best delivered by the hepatology team in parallel with active disease management. This includes ensuring that discussions about disease trajectory and advance care planning occur alongside active management of disease complications. Liver disease is strongly associated with significant social, psychological and financial hardships for patients and their carers; strategies that involve the wider multidisciplinary team at an early stage in the disease trajectory help ensure proactive management of such issues. This review summarises the evidence supporting palliative care for patients with advanced chronic liver disease, presents examples of current best practice and provides pragmatic suggestions for how palliative and disease-modifying care can be run in parallel, such that patients do not miss opportunities for interventions that improve their quality of life.

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“…(65) For currently practicing hepatology physicians and advanced practice providers, continued medical education as well as up-to-date resources on symptom management may enhance PC delivery in everyday practice. (66) Increased provider awareness of the importance of HRQOL (eg, how a patient or caregiver feels physically and emotionally), which can be measured at the point of care, may enhance the delivery of compassionate care focused on patient well-being. Finally, and most importantly, better NOTE: For more information about these studies, go to www.clinicaltrials.gov.…”

Section: Future Directionsmentioning

confidence: 99%

Current Knowledge, Barriers to Implementation, and Future Directions in Palliative Care for End‐Stage Liver Disease

Fricker

Serper

2019

Liver Transpl

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End‐stage liver disease (ESLD) is associated with a high degree of morbidity and mortality as well as symptom burden. Despite this, the rate of consultation with palliative care (PC) providers remains low, and invasive procedures near the end of life are commonplace. Studies show that involvement of PC providers improves patient satisfaction, and evidence from other chronic diseases demonstrates reduced costs of care and potentially increased survival. Better integration of PC is imperative but hindered by patient and provider misconceptions about its role in the care of patients with ESLD, specifically among candidates for liver transplantation. Additionally, reimbursement barriers and lack of provider knowledge may contribute to PC underutilization. In this review, we discuss the benefits of PC in ESLD, the variability of its delivery, and key stakeholders’ perceptions about its use. Additionally, we identify barriers to more widespread PC adoption and highlight areas for future research.

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

Cited by 50 publications

References 66 publications

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index

Palliative care in liver disease: what does good look like?

Current Knowledge, Barriers to Implementation, and Future Directions in Palliative Care for End‐Stage Liver Disease

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