1 Center for Palliative and Supportive Care, University of Alabama at Birmingham , Birmingham, Alabama.
2 Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.
J Palliat Med. 2018 Aug;21(8):1177-1184. doi: 10.1089/jpm.2017.0656. Epub 2018 Apr 26.
Patients with decompensated cirrhosis (DC) and/or hepatocellular carcinoma (HCC) have a high symptom burden and mortality and may benefit from palliative care (PC) and hospice interventions.
Our aim was to search published literature to determine the impact of PC and hospice interventions for patients with DC/HCC.
We searched electronic databases for adults with DC/HCC who received PC, using a rapid review methodology. Data were extracted for study design, participant and intervention characteristics, and three main groups of outcomes: healthcare resource utilization (HRU), end-of-life care (EOLC), and patient-reported outcomes.
Of 2466 results, eight were included in final results. There were six retrospective cohort studies, one prospective cohort, and one quality improvement study. Five of eight studies had a high risk of bias and seven studied patients with HCC. A majority found a reduction in HRU (total cost of hospitalization, number of emergency department visits, hospital, and critical care admissions). Some studies found an impact on EOLC, including location of death (less likely to die in the hospital) and resuscitation (less likely to have resuscitation). One study evaluated survival and found hospice had no impact and another showed improvement of symptom burden.
Studies included suggest that PC and hospice interventions in patients with DC/HCC reduce HRU, impact EOLC, and improve symptoms. Given the few number of studies, heterogeneity of interventions and outcomes, and high risk of bias, further high-quality research is needed on PC and hospice interventions with a greater focus on DC.
失代偿期肝硬化（DC）和/或肝细胞癌（HCC）患者的症状负担和死亡率较高，可能受益于姑息治疗（PC）和临终关怀干预。
我们旨在搜索已发表的文献，以确定 PC 和临终关怀干预对 DC/HCC 患者的影响。
我们使用快速审查方法，在电子数据库中搜索接受 PC 的 DC/HCC 成年患者。提取研究设计、参与者和干预措施特征以及三个主要结局组的数据：医疗资源利用（HRU）、临终关怀（EOLC）和患者报告结局。
在 2466 项结果中，有 8 项最终结果纳入。其中有 6 项回顾性队列研究、1 项前瞻性队列研究和 1 项质量改进研究。8 项研究中有 5 项存在高偏倚风险，7 项研究对象为 HCC 患者。大多数研究发现 HRU 减少（住院总费用、急诊就诊次数、住院和重症监护病房入院次数）。一些研究发现 EOLC 受到影响，包括死亡地点（更不可能在医院死亡）和复苏（更不可能进行复苏）。一项研究评估了生存情况，发现临终关怀对生存没有影响，另一项研究则表明症状负担有所改善。
纳入的研究表明，PC 和临终关怀干预可以减少 DC/HCC 患者的 HRU，影响 EOLC，并改善症状。鉴于研究数量较少、干预措施和结局的异质性以及高偏倚风险，需要进一步开展高质量的研究，重点关注 DC 患者的 PC 和临终关怀干预。
