The mortality rate from chronic liver disease in the UK is rising rapidly, and patients with advanced disease have a symptom burden comparable to or higher than that experienced in other life-limiting illnesses. While evidence is limited, there is growing recognition that care of patients with advanced disease needs to improve. Many factors limit widespread provision of good palliative care to these patients, including the unpredictable trajectory of chronic liver disease, the misconception that palliative care and end-of-life care are synonymous, lack of confidence in prescribing and lack of time and resources. Healthcare professionals managing these patients need to develop the skills to ensure effective delivery of core palliative care, with referral to specialist palliative care services reserved for those with complex needs. Core palliative care is best delivered by the hepatology team in parallel with active disease management. This includes ensuring that discussions about disease trajectory and advance care planning occur alongside active management of disease complications. Liver disease is strongly associated with significant social, psychological and financial hardships for patients and their carers; strategies that involve the wider multidisciplinary team at an early stage in the disease trajectory help ensure proactive management of such issues. This review summarises the evidence supporting palliative care for patients with advanced chronic liver disease, presents examples of current best practice and provides pragmatic suggestions for how palliative and disease-modifying care can be run in parallel, such that patients do not miss opportunities for interventions that improve their quality of life.
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http://dx.doi.org/10.1136/flgastro-2019-101180 | DOI Listing |
Digit Health
December 2024
Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark.
Objective: During the COVID-19 pandemic, changes were made in cancer care including increased use of teleconsultations (TCs) and restrictions for relatives to attend in-person appointments at the outpatient clinics. This study aimed to provide in-depth information on healthcare professionals' experiences of TC and the limited access for relatives during the COVID-19 pandemic in 2020.
Methods: This qualitative study was conducted at an oncological department responsible for oncological care of all patients with cancer in one of five health regions in Denmark.
Ann Surg Open
December 2024
Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
Background: Although resection is generally necessary for curative-intent treatment of most solid organ cancers, surgery is occasionally aborted due to intraoperative findings. Following aborted cancer surgery, patients have unique care needs that specialized palliative care (PC) providers may be best equipped to manage. We hypothesized that early ambulatory PC referral following aborted cancer surgery would be feasible and acceptable.
View Article and Find Full Text PDFAnn Surg Open
December 2024
Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK.
Objective: To synthesize evidence of surgical treatment intensity, defined as a measure of the quantity of invasive procedures, received by patients in patients with cancer within a defined time period around the 'end of life' (EoL).
Background: Concern regarding overly 'aggressive' care or high health care utilization at the EoL, particularly in cancer, is growing. The contribution surgery makes to the quality and cost of EoL care in cancer has not yet been quantified.
With advancements in breast cancer treatment, survivorship has increased, leading to 3.8 million survivors in the US. These women have diverse supportive care needs, often addressed through Survivorship Programs (SPs), which provide clinical and non-clinical support services.
View Article and Find Full Text PDFInform Health Soc Care
December 2024
Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
CarerHelp is an online resource supporting Australian family carers providing palliative care to loved ones at home. To confidently care for a dying person, family carers require access to evidence-based resources, accessible day or night when healthcare professionals or services are unavailable. Given carer diversity, usability evaluations assist online developers in shaping information experiences to family carer's needs and abilities.
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