Abstract
Background: Patients with decompensated cirrhosis (DC) and/or hepatocellular carcinoma (HCC) have a high symptom burden and mortality and may benefit from palliative care (PC) and hospice interventions. Objective: Our aim was to search published literature to determine the impact of PC and hospice interventions for patients with DC/HCC. Methods: We searched electronic databases for adults with DC/HCC who received PC, using a rapid review methodology. Data were extracted for study design, participant and intervention characteristics, and three main groups of outcomes: healthcare resource utilization (HRU), end-of-life care (EOLC), and patient-reported outcomes. Results: Of 2466 results, eight were included in final results. There were six retrospective cohort studies, one prospective cohort, and one quality improvement study. Five of eight studies had a high risk of bias and seven studied patients with HCC. A majority found a reduction in HRU (total cost of hospitalization, number of emergency department visits, hospital, and critical care admissions). Some studies found an impact on EOLC, including location of death (less likely to die in the hospital) and resuscitation (less likely to have resuscitation). One study evaluated survival and found hospice had no impact and another showed improvement of symptom burden. Conclusion: Studies included suggest that PC and hospice interventions in patients with DC/HCC reduce HRU, impact EOLC, and improve symptoms. Given the few number of studies, heterogeneity of interventions and outcomes, and high risk of bias, further high-quality research is needed on PC and hospice interventions with a greater focus on DC.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1177-1184 |
| Number of pages | 8 |
| Journal | Journal of palliative medicine |
| Volume | 21 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 2018 |
Bibliographical note
Funding Information:We acknowledge and thank University of Alabama at Birmingham Lister Hill Library, specifically, Carolyn Holmes and Geeta Malik for assistance in the search process. This work was supported, in part, by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. S.K.M. is supported by a T32 in Health Services and Outcomes Research (Agency for Healthcare Research and Quality [AHRQ] T32HS013852). The contents of this publication are the sole responsibility of the authors and do not represent the official views of the NIH or AHRQ.
Publisher Copyright:
© Copyright 2018, Mary Ann Liebert, Inc. 2018.
Keywords
- cirrhosis
- liver disease
- palliative care
- rapid review
- symptoms
- utilization
