ABSTRACT

Introduction

Patients with end-stage liver disease (ESLD) have impaired physical, psychological, and social functions, which can diminish patient quality of life, burden family caregivers, and increase health-care utilization. For those with a life expectancy of less than six months, these impairments and their downstream effects can be addressed effectively through high-quality hospice care, delivered by multidisciplinary teams and focused on the physical, emotional, social, and spiritual wellbeing of patients and caregivers, with a goal of improving quality of life.

Areas Covered

In this review, we examine the evidence supporting hospice for ESLD, we compare this evidence to that supporting hospice more broadly, and we identify potential criteria that may be useful in determining hospice appropriateness.

Expert Opinion

Despite the potential for hospice to improve care for those at the end of life, it is underutilized for patients with ESLD. Increasing the appropriate utilization of hospice for ESLD requires a better understanding of patient eligibility, which can be based on predictors of high short-term mortality and liver transplant ineligibility. Such hospice criteria should be data-driven and should accommodate the uncertainty faced by patients and physicians.

中文翻译：

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美国终末期肝病的临终关怀

摘要

介绍

终末期肝病 (ESLD) 患者的身体、心理和社会功能受损，这会降低患者的生活质量，给家庭护理人员带来负担，并提高医疗保健利用率。对于那些预期寿命不到六个月的人，这些损伤及其下游影响可以通过多学科团队提供的高质量临终关怀得到有效解决，重点关注患者和护理人员的身体、情感、社会和精神健康，以提高生活质量为目标。

涵盖的领域

在这篇综述中，我们检查了支持 ESLD 临终关怀的证据，我们将这些证据与支持临终关怀的证据进行了更广泛的比较，并确定了可能有助于确定临终关怀适当性的潜在标准。

专家意见

尽管临终关怀有可能改善对临终者的护理，但它对 ESLD 患者的利用不足。增加对 ESLD 临终关怀的适当利用需要更好地了解患者的资格，这可以基于高短期死亡率和肝移植不合格的预测因素。这种临终关怀标准应该是数据驱动的，并且应该适应患者和医生面临的不确定性。