Serious illness communication in cirrhosis care: Tools to improve illness understanding, prognostic understanding and care planning

Patients with cirrhosis frequently experience an unpredictable illness trajectory, with frequent hospitalizations and complications. Along with the uncertain nature of the disease, the possibility of a life-saving and curative transplant often makes prognostic discussions and future care decisions challenging. Serious illness communication (SIC) refers to supportive communication whereby clinicians assess patients’ illness understanding, share prognostic information according to patients’ preferences, explore patients’ goals and make recommendations for care that align with these goals. SIC includes three key components: 1) illness understanding 2) prognostic understanding and 3) care planning. In this piece we explore current barriers to early implementation of SIC in cirrhosis care and share possible solutions, including adopting a multidisciplinary approach, delivering culturally competent care, and training clinicians in SIC core skills. By use of a case example, we aim to demonstrate SIC in action and to provide clinicians with tools and skills that can be used in practice.