Abstract
Dear Editor:
End-Stage Liver Disease (ESLD) is 1 of the 10 leading causes of death in United States. 1 It is marked by episodic acute exacerbations of the underlying liver disease that often leads to severe symptoms, poor quality of life, mental deterioration, and repeated hospitalizations. Hospitalization rates due to ESLD and its complications have skyrocketed by 93% due to hepatorenal syndrome, 62% due to portal hypertension, and 190% due to Hepatitis C and its complications from 2004–2005 to 2010–2011. 2 The only cure for ESLD is a liver transplant, which is not available to majority of the patients due to limitations in resources and strict criteria for candidate eligibility. Caregiver burden is usually very high, irrespective of the transplant status of the patient. Caregivers especially those involved in medical decision making undergo high level of stress before, during, and after liver transplantation.
Palliative care (PC) is an evolving subspecialty that has gone beyond hospice and end-of-life care, to include goals of care discussions, symptom management, and helping patients live better quality of life, in addition to offering support to caregivers. In 2014, the World Health Assembly announced the inclusion of PC within the definition of “universal health coverage,” that is, providing integrated PC to address all patients’ and families’ needs while suffering from a serious illness. 3 PC has shown to reduce healthcare costs, improve quality of care, and communication between patients/families and their providers in oncology settings. 4 Despite the clear benefits, ESLD patients rarely receive PC at an early stage of the disease. Likewise, there is no standard model for integrating PC services within a specialty practice such as hepatology, where most of the ESLD care occurs.
To summarize, PC can help reduce the symptom burden, enhance the quality of life, and offer emotional support to patients and their families. It can help improve patient satisfaction and reduce healthcare resource utilization. Rigorous multicenter research aiming to demonstrate the feasibility, efficacy, and effectiveness of different kinds of PC delivery approaches (e.g., integrated collaborative onsite access to PC vs. referral to a local PC clinic vs. trained hepatologist-led PC using remote monitoring of symptoms) is needed. Furthermore, the timing of integration must be tested, that is, early versus delayed PC. The evidence generated could possibly inform a change in routine management of ESLD patients.