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Review
Palliative care in liver disease: what does good look like?
  1. Hazel Woodland1,
  2. Ben Hudson2,
  3. Karen Forbes3,
  4. Anne McCune4,
  5. Mark Wright5
  6. On Behalf of the British Association for the Study of the Liver (BASL) End of Life Special Interest Group
  1. 1Department of Hepatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2Department of Hepatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  3. 3Population Health Sciences, University of Bristol, Bristol, UK
  4. 4Department of Liver Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  5. 5Department of Hepatology, University Hospital Southampton, Southampton, UK
  1. Correspondence to Dr Hazel Woodland, Hepatology, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, UK; hw17577{at}bristol.ac.uk

Abstract

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.

  • cirrhosis
  • end of life

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Footnotes

  • Contributors MW conceived the original idea for the review. HW performed the literature search, wrote the manuscript and is the guarantor for the article. MW, BH, AM and KF all read and edited early and final drafts of the review and contributed specialist clinical knowledge.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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