{"doi":"10.1002/cld.936","title":"Integrating Palliative Care in the Management of Patients With Advanced Liver Disease","abstract":"Watch a video presentation of this article Being diagnosed with an advanced liver disease (ALD), such as decompensated cirrhosis or hepatocellular carcinoma, has a dramatic impact on both life expectancy and quality of life for afflicted individuals.1, 2 Although many scientific achievements in the field of hepatology have led to improved survival in these cohorts of patients, curative options are still unavailable for most.3, 4 Much less attention has been paid to improving the quality of life for these patients, which is expected to be a growing need. Integrating principles of palliative care in the management of patients with ALD may be one way of solving this issue. The National Consensus Project Guidelines define palliative care as a “person- and family-centered approach to care, providing people living with serious illness relief from the symptoms and stress of an illness”.5 The ultimate goal of palliative care is to improve quality of life for the patient and the family. Important dimensions of palliative care include: (1) physical symptom management; (2) mental health management; (3) advance care planning (ACP); (4) addressing social and cultural issues; (5) addressing spiritual, religious, and existential issues; and (6) end-of-life care. Ideally, it is offered across all practice settings, at any stage of a patient’s illness trajectory, and with the involvement of multiple disciplines.5 It is thus important to recognize that palliative care is not synonymous with end-of-life care or hospice (Fig. 1A and 1B). Depending on the resources available in different health care settings, palliative care can be offered by generalists (without specialty training in palliative care) or specialists (have received training).6 Interdisciplinary teams include not only physicians but also advanced practice registered nurses, physician assistants, nurses, social workers, behavioral health specialists, chaplains, and others based on need.5 Early palliative care involvement has been associated with improvements in patient and caregiver satisfaction, as well as lower health care utilization.7 In fact, results from a high-quality randomized controlled trial suggest that early palliative care consultation in patients with advanced cancer is associated with better quality of life and mood. The authors of this study hypothesized that this may be due to improvements in coordinated care, self-advocacy, and social support.8 Benefits in physical and depressive symptoms have also been seen in a smaller, noncontrolled study of patients with ALD who received palliative care consultation during transplant evaluation.9 Multiple subspecialty societies treating patients with advanced cancer, end-stage renal disease (ESRD), heart failure, chronic obstructive pulmonary disease, and other chronic conditions recommend inclusion of early palliative care as part of their management. Despite this, involvement of specialty palliative for patients with ALD is low.10, 11 In the following paragraphs, we will highlight ACP and symptom management, two particularly unmet needs for palliative care in ALD, and provide strategies for managing these issues in practice or considering specialty referral. ACP is the iterative process by which patients and their caregivers clarify, establish, and document their illness and prognostic understanding, personal values and health goals, and preferences for medical care throughout the course of their illness.12 Timely ACP has been associated with a number of positive outcomes for patients, including improved quality of life and satisfaction with care, as well as reduced health care utilization at end of life.13 Unfortunately, ACP occurs infrequently. In a prospective study of outpatients with cirrhosis, only 14% of patients had completed a goals of care designation, and only 33% had identified a surrogate decision-maker.14 Surveys of clinicians providing care to patients with ALD have identified insufficient clinician communicati","journal":"Clinical Liver Disease","year":2020,"id":73978,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":12,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9571,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":226668,"name":"Nneka N. Ufere","orcid":"0000-0001-8255-9374","position":1,"is_corresponding":false},{"id":225413,"name":"Arpan Patel","orcid":"0000-0002-6548-4531","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-18T21:45:52.171053Z","pmid":"32395238","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}