Published online Dec 20, 2024. doi: 10.5662/wjm.v14.i4.95904
Revised: June 20, 2024
Accepted: July 3, 2024
Published online: December 20, 2024
Processing time: 95 Days and 11.8 Hours
End stage liver disease (ESLD) represents a growing health concern characterized by elevated morbidity and mortality, particularly among individual ineligible for liver transplantation. The demand for palliative care (PC) is pronounced in patients grappling with ESLD and acute on chronic liver failure (ACLF). Unfortunately, the historical underutilization of PC in ESLD patients, despite their substantial needs and those of their family caregivers, underscores the imperative of seamlessly integrating PC principles into routine healthcare practices across the entire disease spectrum.
To comprehensively investigate the evidence surrounding the benefits of inco
A systematic search in the Medline (PubMed) database was performed using a predetermined search command, encompassing studies published in English without any restrictions on the publication date. Subsequently, the retrieved studies were manually examined. Simple descriptive analyses were employed to summarize the results.
The search strategies yielded 721 references. Following the final analysis, 32 full-length references met the inclusion criteria and were consequently incorporated into the study. Meticulous data extraction from these 32 studies was undertaken, leading to the execution of a comprehensive narrative systematic review. The review found that PC provides significant benefits, reducing symptom burden, depressive symptoms, readmission rates, and hospital stays. Yet, barriers like the appeal of transplants and misconceptions about PC hinder optimal utilization. Integrating PC early, upon the diagnosis of ESLD and ACLF, regardless of transplant eligibility and availability, improves the quality of life for these patients.
Despite the substantial suffering and poor prognosis associated with ESLD and ACLF, where liver transplantation stands as the only curative treatment, albeit largely inaccessible, PC services have been overtly provided too late in the course of the illness. A comprehensive understanding of PC's pivotal role in treating ESLD and ACLF is crucial for overcoming these barriers, involving healthcare providers, patients, and caregivers.
Core Tip: This systematic review addresses the underexplored utilization of palliative care (PC) in patients with end stage liver disease (ESLD) and acute on chronic liver failure (ACLF), a demographic traditionally underserved. ESLD and ACLF are characterized by grim prognoses, substantial care costs, explicit patient suffering, and elevated mortality rates. Despite liver transplantation (LT) being a curative option, accessibility remains severely limited due to barriers such as donor scarcity, financial constraints, and inadequate social support. Even among those eligible for transplantation, a significant majority of ESLD patients are referred late for PC, typically within their final couple of weeks of life. PC offers notable benefits, including amelioration of symptom burden, reduced depressive symptoms, lower readmission rates, and shorter hospital stays. However, optimal utilization of PC faces barriers such as the allure of transplants and misconceptions about PC. A comprehensive understanding of the pivotal role of PC in ESLD and ACLF treatment is crucial for all stakeholders, including healthcare providers, patients, and caregivers, to overcome these barriers. Future prospective randomized studies, irrespective of LT eligibility, are needed to strengthen the evidence supporting early integration of PC in the management of ESLD/ACLF patients.