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Palliative care and end-stage liver disease

a critical review of current knowledge

Rakoski, Mina O.; Volk, Michael L.

Current Opinion in Gastroenterology: May 2019 - Volume 35 - Issue 3 - p 155–160
doi: 10.1097/MOG.0000000000000530
LIVER: Edited by Don C. Rockey

Purpose of review End-stage liver disease (ESLD) is associated with high symptom burden, poor quality of life, and significant healthcare costs. Palliative care, which is not synonymous with hospice or end-of-life care, is a multidisciplinary model of care that focuses on patient-centered goals with the intent of improving quality of life and reducing suffering. This review will summarize current literature supporting the benefits of early integration of palliative care in patients in this population.

Recent findings Advance care planning (ACP) and goals of care discussions have been associated with improved quality of life, decreased anxiety, and improved satisfaction with care for both the patient and the caregiver. These discussions are beneficial to all patients with ESLD, including those listed for liver transplantation.

Summary Despite the resounding benefits of palliative care for patients with other advanced diseases, palliative care remains underutilized in liver disease. There is an urgent need for education of hepatology/transplant providers as well as development of society guidelines to help dissemination and acceptability of palliative care for patients with ESLD.

Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, California, USA

Correspondence to Mina O. Rakoski, Loma Linda University Health, 25865 Barton Road, Sute 101, Loma Linda, CA 92354, USA. Tel: +1 909 558 3636; fax: +1 909 558 3759; e-mail:

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