Division of Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Liver Transpl. 2019 May;25(5):787-796. doi: 10.1002/lt.25434. Epub 2019 Apr 5.
End-stage liver disease (ESLD) is associated with a high degree of morbidity and mortality as well as symptom burden. Despite this, the rate of consultation with palliative care (PC) providers remains low, and invasive procedures near the end of life are commonplace. Studies show that involvement of PC providers improves patient satisfaction, and evidence from other chronic diseases demonstrates reduced costs of care and potentially increased survival. Better integration of PC is imperative but hindered by patient and provider misconceptions about its role in the care of patients with ESLD, specifically among candidates for liver transplantation. Additionally, reimbursement barriers and lack of provider knowledge may contribute to PC underutilization. In this review, we discuss the benefits of PC in ESLD, the variability of its delivery, and key stakeholders' perceptions about its use. Additionally, we identify barriers to more widespread PC adoption and highlight areas for future research.
终末期肝病（ESLD）与高发病率、高死亡率以及症状负担相关。尽管如此，患者向姑息治疗（PC）提供者咨询的比例仍然很低，在生命末期进行有创性治疗的情况也很常见。研究表明，PC 提供者的参与可以提高患者的满意度，来自其他慢性疾病的证据表明，PC 可以降低护理成本，并可能提高生存率。更好地整合 PC 是必要的，但受到患者和提供者对其在 ESLD 患者护理中的作用的误解的阻碍，特别是在肝移植候选者中。此外，报销障碍和提供者知识的缺乏可能导致 PC 的使用不足。在这篇综述中，我们讨论了 PC 在 ESLD 中的益处、其提供方式的可变性，以及关键利益相关者对其使用的看法。此外，我们确定了更广泛采用 PC 的障碍，并强调了未来研究的领域。
