Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California.
Clin Gastroenterol Hepatol. 2021 Apr;19(4):646-656.e3. doi: 10.1016/j.cgh.2020.11.027. Epub 2020 Nov 19.
Care with palliative care principles (aka Palliative Care, PC) is an approach to care that focuses on improving the quality of life of patients and their caregivers who are facing life-limiting illness. It encompasses the assessment and management of symptoms and changes in functional status, the provision of advance care planning and goals of care discussions, prognostication and caregiver support. PC is applicable across the spectrum of cirrhosis regardless of transplant eligibility. Although a common misconception, PC is not synonymous with hospice care. Unfortunately, despite a high symptom burden and challenges with predicting disease course and mounting evidence to support the benefits of PC in patients with cirrhosis, comprehensive PC and referral to hospice are carried out infrequently and very late in the course of disease. In order to meet the needs of our increasingly prevalent cirrhosis population, it is important that all clinicians who care for these patients are able to work together to deliver PC as a standard of care. To date there are limited guidelines/guidance statements to direct clinicians in the area of PC and cirrhosis. Herein we present an evidence-based review of ten Best Practice Advice statements that address key issues pertaining to PC in patients with cirrhosis.
关怀遵循舒缓治疗原则（又名舒缓治疗、PC）是一种护理方法，侧重于改善面临生命末期疾病的患者及其护理人员的生活质量。它包括评估和管理症状以及功能状态的变化，提供预先护理计划和护理目标的讨论、预后判断和护理人员的支持。PC 适用于肝硬化的整个范围，无论是否有移植资格。尽管这是一个常见的误解，但 PC 与临终关怀并不相同。不幸的是，尽管肝硬化患者的症状负担很高，并且预测疾病过程和支持 PC 对患者有益的证据存在挑战，但综合 PC 以及向临终关怀的转介在疾病过程中很少进行，而且非常晚。为了满足我们日益增多的肝硬化患者的需求，护理这些患者的所有临床医生都能够共同努力，将 PC 作为护理标准提供，这一点非常重要。迄今为止，在 PC 和肝硬化领域，指导临床医生的指南/指导声明有限。在此，我们提出了一份基于证据的审查，其中包含十个与肝硬化患者 PC 相关的关键问题的最佳实践建议声明。
