Nonhospice Palliative Care within the Treatment of End Stage Liver Disease

Palliative care (PC) that has evolved from a focus on end of life care to an expanded form of holistic care at an early stage for patients with serious illnesses and their families is commonly referred to as nonhospice PC (or early PC). Patients with end stage liver disease (ESLD) suffer from a high symptom burden, deteriorated quality of life with uncertain prognosis and limited treatment options. Caregivers of these patients also bear the emotional and physical burden similar to cancer caregivers. Despite proven benefits of nonhospice PC in other serious illnesses and cancer, there are no evidence-based structures and processes to support its integration within the routine care of ESLD patients and their caregivers. In this article, we review the current state of PC within ESLD, and propose key structures and processes to integrate nonhospice PC within routine hepatology practice. Results found that PC is highly underutilized within ESLD care, and limited prospective studies are available to demonstrate methods to integrate PC within routine hepatology practices. Hepatology providers reported lack of training to deliver PC along with no clear prognostic criteria on when to initiate PC. A well informed model with key structures and processes for nonhospice PC integration would allow hepatology providers to improve clinical outcomes, ESLD patients' quality of life, as well as reduce healthcare costs. Educating the hepatology providers about PC principles and developing clear prognostic criteria for when and how to integrate PC based on individual patient needs are the initial steps to inform the integration. The fields of nonhospice PC and hepatology have ample opportunities to partner clinically and academically.