Mafi Vakaola I Pulotu, Soldera Jonathan
Post-Graduate Program, Acute Medicine, University of South Wales, Cardiff CF37 1DL, United Kingdom.
World J Methodol. 2024 Dec 20;14(4):95904. doi: 10.5662/wjm.v14.i4.95904.
End stage liver disease (ESLD) represents a growing health concern characterized by elevated morbidity and mortality, particularly among individual ineligible for liver transplantation. The demand for palliative care (PC) is pronounced in patients grappling with ESLD and acute on chronic liver failure (ACLF). Unfortunately, the historical underutilization of PC in ESLD patients, despite their substantial needs and those of their family caregivers, underscores the imperative of seamlessly integrating PC principles into routine healthcare practices across the entire disease spectrum.
To comprehensively investigate the evidence surrounding the benefits of incorporating PC into the comprehensive care plan for individuals confronting ESLD and/or ACLF.
A systematic search in the Medline (PubMed) database was performed using a predetermined search command, encompassing studies published in English without any restrictions on the publication date. Subsequently, the retrieved studies were manually examined. Simple descriptive analyses were employed to summarize the results.
The search strategies yielded 721 references. Following the final analysis, 32 full-length references met the inclusion criteria and were consequently incorporated into the study. Meticulous data extraction from these 32 studies was undertaken, leading to the execution of a comprehensive narrative systematic review. The review found that PC provides significant benefits, reducing symptom burden, depressive symptoms, readmission rates, and hospital stays. Yet, barriers like the appeal of transplants and misconceptions about PC hinder optimal utilization. Integrating PC early, upon the diagnosis of ESLD and ACLF, regardless of transplant eligibility and availability, improves the quality of life for these patients.
Despite the substantial suffering and poor prognosis associated with ESLD and ACLF, where liver transplantation stands as the only curative treatment, albeit largely inaccessible, PC services have been overtly provided too late in the course of the illness. A comprehensive understanding of PC's pivotal role in treating ESLD and ACLF is crucial for overcoming these barriers, involving healthcare providers, patients, and caregivers.
终末期肝病（ESLD）是一个日益受到关注的健康问题，其特点是发病率和死亡率不断上升，尤其是在那些不适合肝移植的个体中。对于患有ESLD和慢性肝功能衰竭急性发作（ACLF）的患者，姑息治疗（PC）的需求十分显著。不幸的是，尽管ESLD患者及其家庭护理人员有大量需求，但PC在历史上一直未得到充分利用，这凸显了将PC原则无缝融入整个疾病谱的常规医疗实践的紧迫性。
全面调查将PC纳入ESLD和/或ACLF患者综合护理计划的益处的相关证据。
使用预先确定的搜索命令在Medline（PubMed）数据库中进行系统搜索，涵盖以英文发表的研究，对出版日期无任何限制。随后，对检索到的研究进行人工审查。采用简单描述性分析来总结结果。
搜索策略产生了721篇参考文献。经过最终分析，32篇全文参考文献符合纳入标准，因此被纳入研究。对这32项研究进行了细致的数据提取，从而进行了全面的叙述性系统评价。该评价发现，PC带来显著益处，可减轻症状负担、抑郁症状、再入院率和住院时间。然而，诸如移植的吸引力和对PC的误解等障碍阻碍了其最佳利用。在诊断ESLD和ACLF时尽早整合PC，无论移植资格和可及性如何，都能改善这些患者的生活质量。
尽管ESLD和ACLF带来巨大痛苦且预后不良，肝移植是唯一的治愈性治疗方法，尽管大多无法获得，但PC服务在病程中提供得太晚。全面理解PC在治疗ESLD和ACLF中的关键作用对于克服这些障碍至关重要，涉及医疗服务提供者·患者和护理人员。
