1 Division of Liver Disease, Icahn School of Medicine at Mount Sinai, New York, New York.
2 Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Palliat Med. 2019 Jul;22(7):804-813. doi: 10.1089/jpm.2018.0553. Epub 2019 Mar 20.
Delays in specialized palliative care (PC) consultation in end-stage liver disease (ESLD) patients may be explained by clinician attitudes toward PC. Our aim is to assess the attitudes of hepatology and liver transplant (HLT) and PC clinicians toward PC consultation and consultant roles in ESLD patient care. Clinician members of HLT and PC professional societies were surveyed. Using a five-point Likert scale, they rated their comfort level toward various PC consultant roles and their agreement with triggers for and reasons to defer PC consultation. Change in attitudes toward PC consultation resulting from liver transplant (LT) eligibility was evaluated. A total of 311 HLT (6.2%) and 379 PC (8.1%) clinicians completed the survey. The vast majority of HLT clinicians (>80%) were comfortable if PC consultants palliate symptoms, provide support, or facilitate advance care planning in LT- patients. LT eligibility reduced HLT clinician comfort toward all PC consultant roles, except supportive care. A vast majority of PC clinicians (>90%) were comfortable assuming all PC roles, except pain management without opioids (43-51%). About 80% of HLT clinicians agree with PC consultation in LT- patients with decompensated cirrhosis or hepatocellular carcinoma (HCC), compared to 20-30% if LT . Common justifications for deferring PC consultation included mild disease, LT eligibility, unavailability of PC specialists, and lack of addressable palliative issues. Barriers to specialized PC consultation in ESLD include HLT clinician discomfort with PC consultant roles, patients' LT eligibility, perception that PC is end-of-life care, unclear triggers for PC consultation, and concern about opioid-based pain palliation.
在终末期肝病 (ESLD) 患者中，专业姑息治疗 (PC) 咨询的延迟可能与临床医生对 PC 的态度有关。我们的目的是评估肝病学和肝移植 (HLT) 和 PC 临床医生对 ESLD 患者护理中 PC 咨询和顾问角色的态度。调查了 HLT 和 PC 专业协会的临床医生成员。他们使用五点李克特量表对各种 PC 顾问角色的舒适度以及对 PC 咨询的触发因素和推迟原因的认同程度进行了评分。评估了由于肝移植 (LT) 资格而导致对 PC 咨询态度的变化。共有 311 名 HLT（6.2%）和 379 名 PC（8.1%）临床医生完成了调查。绝大多数 HLT 临床医生（>80%）在 PC 顾问缓解 LT 患者的症状、提供支持或促进预先护理计划时感到舒适。LT 资格降低了 HLT 临床医生对所有 PC 顾问角色的舒适度，除了支持性护理。绝大多数 PC 临床医生（>90%）对承担所有 PC 角色感到舒适，除了没有阿片类药物的疼痛管理（43-51%）。约 80%的 HLT 临床医生同意在失代偿性肝硬化或肝细胞癌 (HCC) 的 LT-患者中进行 PC 咨询，而如果 LT 的话，同意的比例为 20-30%。推迟 PC 咨询的常见理由包括疾病轻微、LT 资格、PC 专家不可用以及缺乏可解决的姑息问题。ESLD 中专业 PC 咨询的障碍包括 HLT 临床医生对 PC 顾问角色的不适、患者的 LT 资格、对 PC 是终末期护理的看法、PC 咨询的触发因素不明确以及对基于阿片类药物的疼痛缓解的担忧。
