Palliative Care Interventions in End-Stage Liver Disease: A Rapid Review of Literature (FR461C)

Abstract

•Summarize the 16 final included studies and describe the types of study design, interventions, measured outcomes, quality assessment, and future research needs.•Describe features of a rapid review compared to a systematic review that make this methodology more accessible to trainees, practicing clinicians, and policy-makers. Of the 400,000 patients with end-stage liver disease (ESLD) in the United States, approximately 2% of patients are transplanted, with the remainder dying from liver disease. These patients have high symptom burden and may benefit from palliative care (PC) intervention. Our objective was to review the evidence for PC interventions in patients with end-stage liver disease with an effective and time-efficient methodology, the rapid review. We reviewed six databases (PubMed, EMBASE, CINAHL, Psych Info, ClinicalTrials.gov, Cochrane) for adults with ESLD and hepatocellular carcinoma (HCC) who received PC. We included patients with HCC since most have liver cirrhosis and similar symptoms with disease progression. We excluded pharmacological and procedural interventions and included PC provider interventions focusing on communication regarding patient prognosis, goals of care, symptom management, and focused end-of-life care. Data were extracted for study design, participant and intervention characteristics, and three main groups of outcomes: patient-centered outcomes (symptoms, quality-of-life, etc.), quality-of-death outcomes (receiving focused end-of-life care, advanced directives, concordance of actual care with wishes, etc.), and healthcare resource utilization (ER visits, hospitalizations, lengths of stay, costs of treatment, etc.). Our search resulted in 2,460 studies. After de-duplication and exclusion criteria applied, 16 studies were included. There was one RCT and 15 non-randomized studies. A majority (10) were focused on HCC and the others (6) on non-malignant ESLD. Interventions included inpatient PC consultation (5), inpatient hospice (3), outpatient hospice (3), outpatient PC (3), and a combination (2). A majority of the outcomes were healthcare resource utilization (12), with others being quality-of-death (7) and patient-centered outcomes (5). There is a lack of high quality research in PC interventions for ESLD and HCC. Future research should focus on development of a PC intervention specific to ESLD, higher quality methods including RCTs, with a greater emphasis on patient-centered outcomes.