Optimising End of Life Care for Patients With End Stage Liver Disease: A Review

Purpose of Review This review describes the challenges and possible solutions for improving access for patients with end stage liver disease to palliative care expertise. Although progress has been made, with consensus guidelines being published by learned societies, there remains significant variability. Recent Findings The developing evidence base describes improved medical and psychological outcomes for patients and caregivers when access to skilled palliative care exists. This may be provided by palliative care specialists or hepatologists/specialist nurses who have been upskilled. These skills include the ability to describe prognostic uncertainty, focussed inquiry into liver failure-related symptoms, pharmacology in liver disease, and awareness of liver transplantation indications/contra-indications. Willingness to engage sensitively in advance care planning, which is integral to improved patient experience, reduced admissions and establishment of the patient’s goals, is required by all clinical staff who care for end stage liver disease patients. Barriers to engagement are located at the patient, physician/nurse and organisational levels. Summary Future organisational and clinical strategies to promote access to palliative care include: specialist multidisciplinary clinics, advanced liver disease multidisciplinary meetings (MDM), empowerment of allied health team members, collaborations, ambulatory/day care units, physician education and patient education. Further high-quality research, including randomised controlled trials, is required to strengthen the evidence base and focus resources.