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Palliative care and end stage liver disease: a survey study comparing perspectives of hepatology and palliative care physicians and clinical scenarios that could require palliative care intervention - 08/07/24

Doi : 10.1016/j.clinre.2024.102416 
Hugo Miguel Oliveira 1, 2, , José Presa Ramos 3 , Francisca Rego 4 , Rui Nunes 4
1 Faculty of Medicine, University of Porto, Porto, Portugal 
2 Palliative Care Unit, Matosinhos Local Health Unit, Portugal 
3 Hepatology Unit of Internal Medicine Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal 
4 Department of Social Sciences and Health, Faculty of Medicine, University of Porto, Porto, Portugal 

Corresponding author: Hugo M Oliveira Department of Social Sciences and Health, Faculty of Medicine, University of Porto Palliative Care Unit, Matosinhos Local Health Unit, Hospital Pedro Hispano, Matosinhos Portugal Rua Dr. Eduardo Torres 4464-513 Senhora da HoraDepartment of Social Sciences and HealthFaculty of Medicine, University of Porto Palliative Care Unit, Matosinhos Local Health Unit, Hospital Pedro HispanoRua Dr. Eduardo Torres 4464-513 Senhora da HoraMatosinhosPortugal
Sous presse. Manuscrit accepté. Disponible en ligne depuis le Monday 08 July 2024

Highlights

Integration of palliative care in end stage liver disease (ESLD) patients is reduced.
There is consensus on referral to palliative care after exclusion from transplant list.
There is a unanimous view of the relevance of training in both areas.
Joint training programs can improve the care provided to ESLD patients.

Le texte complet de cet article est disponible en PDF.

Abstract

Background and aims

The prevalence and mortality of chronic liver disease has risen significantly. In end stage liver disease (ESLD) the survival of patients is approximately 2 years. Despite the poor prognosis and high symptom burden of these patients, integration of palliative care is reduced. We aim to analyze the agreement between palliative care and hepatology physicians of clinical scenarios that could require palliative care intervention.

Methods

A cross-sectional study was conducted. Palliative care and hepatology physicians were surveyed. Using a five-point Likert scale, their perceptions of palliative care in ESLD were rated. Their agreement in clinical scenarios that could require palliative care intervention were evaluated. Analyses were conducted to assess any differences by primary role (hepatology vs. palliative care) and length of practice (<10 years vs. 10 years).

Results

A total of 123 responses were obtained: 52% from palliative care and 48% from hepatology. The majority (66.7%) work in the field for up to ten years. There was a great consensus in 4 of the 8 clinical scenarios. In scenarios with less consensus, the area of activity and length of practice influence the reliance of physicians on palliative care. Involvement of palliative care in ESLD was considered “rare” by 30% and 61% consider difficult to predict the prognosis. More than 90% support medical training in both areas of activity.

Conclusion

The current involvement of palliative care is considered low, but there are clinical conditions that reveal a clear consensus and there's a unanimous view of the relevance of training.

Le texte complet de cet article est disponible en PDF.

Keywords : Palliative Care, End Stage Liver Disease, Hospice, Liver Cirrhosis


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