Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Liver Transpl. 2019 Jun;25(6):859-869. doi: 10.1002/lt.25469. Epub 2019 May 3.
Specialty palliative care (PC) is underused for patients with end-stage liver disease (ESLD). We sought to examine attitudes of hepatologists and gastroenterologists about PC for patients with ESLD. We conducted a cross-sectional survey of these specialists who provide care to patients with ESLD. Participants were recruited from the American Association for the Study of Liver Diseases membership directory. Using a questionnaire adapted from prior studies, we examined physicians' attitudes about PC and whether these attitudes varied based on patients' candidacy for liver transplantation. We identified predictors of physicians' attitudes about PC using linear regression. Approximately one-third of eligible physicians (396/1236, 32%) completed the survey. Most (95%) believed that centers providing care to patients with ESLD should have PC services, and 86% trusted PC clinicians to care for their patients. Only a minority reported collaborating frequently with inpatient (32%) or outpatient (11%) PC services. Most believed that when patients hear the term PC, they feel scared (94%) and anxious (87%). Most (83%) believed that patients would think nothing more could be done for their underlying disease if a PC referral was suggested. Physicians who believed that ESLD is a terminal condition (B = 1.09; P = 0.006) reported more positive attitudes about PC. Conversely, physicians with negative perceptions of PC for transplant candidates (B = -0.22; standard error = 0.05; P < 0.001) reported more negative attitudes toward PC. In conclusion, although most hepatologists and gastroenterologists believe that patients with ESLD should have access to PC, they reported rarely collaborating with PC teams and had substantial concerns about patients' perceptions of PC. Interventions are needed to overcome misperceptions of PC and to promote collaboration with PC clinicians for patients with ESLD.
专业的姑息治疗（PC）在终末期肝病（ESLD）患者中未得到充分应用。我们试图研究肝病学家和胃肠病学家对 ESLD 患者 PC 的态度。我们对这些为 ESLD 患者提供治疗的专家进行了横断面调查。参与者是从美国肝病研究协会的会员名录中招募的。我们使用先前研究中改编的问卷，研究了医生对 PC 的态度，以及这些态度是否因患者是否适合进行肝移植而有所不同。我们使用线性回归确定了医生对 PC 态度的预测因素。大约三分之一符合条件的医生（396/1236，32%）完成了调查。大多数（95%）人认为为 ESLD 患者提供治疗的中心应该提供 PC 服务，并且 86%的人信任 PC 临床医生来照顾他们的患者。只有少数人报告经常与住院（32%）或门诊（11%）PC 服务合作。大多数人认为，当患者听到 PC 一词时，他们会感到害怕（94%）和焦虑（87%）。大多数人（83%）认为，如果建议进行 PC 转诊，患者会认为他们的潜在疾病无法再进行治疗。认为 ESLD 是终末期疾病的医生（B=1.09；P=0.006）对 PC 持更积极的态度。相反，对移植候选者的 PC 持负面看法的医生（B=-0.22；标准误差=0.05；P<0.001）对 PC 的态度更为负面。总之，尽管大多数肝病学家和胃肠病学家认为 ESLD 患者应该能够获得 PC，但他们报告很少与 PC 团队合作，并且对患者对 PC 的看法存在严重担忧。需要采取干预措施来克服对 PC 的误解，并促进与 ESLD 患者的 PC 临床医生合作。
