Advertisement

Current Hepatology Reports

, Volume 17, Issue 1, pp 70–77 | Cite as

Early Integration of Advance Care Planning (ACP) into Cirrhosis Care: Why We Need It

Management of Cirrhotic Patient (A Cardenas and P Tandon, Section Editors)
  • 61 Downloads
Part of the following topical collections:
  1. Topical Collection on Management of the Cirrhotic Patient

Abstract

Purpose of Review

Patients with cirrhosis are largely unaware of the disease trajectory. This review emphasizes the importance of early advance care planning (ACP) and provides practitioners with a framework to apply these concepts.

Recent Findings

Literature is arising describing the importance of ACP and application of palliative principles (symptom management, quality of life, social, spiritual, and emotional care) in cirrhosis care. Understanding illness trajectories can promote symptom control, promote appropriate location of care, and ease care transitions. Our group of practitioners has spent time reviewing literature on ACP and has published tools to educate patients, surrogates, and health practitioners regarding the importance of these principles. In addition, work is ongoing to integrate this very important aspect of care into the daily practice of practitioners who managed end-stage-liver disease.

Summary

Early ACP and integration of palliative principles into cirrhosis care is critical. Provided is an action plan for implementing early ACP into end-stage liver disease (ESLD) care.

Keywords

Advance care planning Cirrhosis End-stage-liver disease Palliative care Personal directives 

Notes

Compliance with Ethical Standards

Conflict of Interest

Amanda Brisebois and Puneeta Tandon each declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Larson AM, Curtis JR. Integrating palliative care for liver transplant candidates: “Too well for transplant, too sick for life”. JAMA. 2006;295:2168–75. Commentary on integrating palliative care principles into cirrhosis care. CrossRefPubMedGoogle Scholar
  2. 2.
    UNOS Donate Life America Statistics. http://donatelife.net/understanding-donation/statistics/. Last Accessed 30 Dec 2017.
  3. 3.
    • Larson A. Palliative Care for Patients with End-Stage Liver Disease. Curr Gastroenterol Rep. 2015;17(5):440. Review on palliative needs of and crucial conversations to take place for ESLD patients, discussing end of life issues and integrating in this patient population. CrossRefPubMedGoogle Scholar
  4. 4.
    • Poonja Z, Brisebois A, van Zanten, SV, Tandon P, Meeberg G, Karvellas CJ. Patients with cirrhosis and denied liver transplants rarely receive adequate palliative care or appropriate management. Clin Gastroenterol Hepatol. 2014;12(4):692–698. Highly cited retrospective study on utilization of palliative care and symptom burden in inpatient delisted patients with ESLD.  https://doi.org/10.1016/j.cgh.2013.08.027.CrossRefPubMedGoogle Scholar
  5. 5.
    Patel A, Walling A, et al. Palliative care and health care utilization for patients with end-stage liver disease at the end of life. Clin Gastroenterol Hepatol. 2017;15(10):1612–9.  https://doi.org/10.1016/j.cgh.2017.01.030.CrossRefPubMedGoogle Scholar
  6. 6.
    WHO Organization. WHO definition of Palliative Care. http://www.who.int/cancer/palliative/definition/en/. Last accessed 17 Jan 2018.
  7. 7.
    Hickman S, Keevern E, Hammes B. Use of the physician orders for life-sustaining treatment program in the clinical setting: a systematic review of the literature. JAGS. 2015;63(2):341–50.CrossRefGoogle Scholar
  8. 8.
    •• Brisebois A, Ismond K, et al. Advance Care Planning (ACP) for specialists managing cirrhosis: a focus on patient-centered care. Baltimore: Wiley; 2017. Overview of ACP and GCD specifically in cirrhosis patients, with practical figures for use in various care settings. Google Scholar
  9. 9.
    Sabatino CP. Regular ArticleAdvance care planning tools that educate, engage, and empower. Public Policy Aging Rep. 2014;24(3):107–11.  https://doi.org/10.1093/ppar/pru018.CrossRefGoogle Scholar
  10. 10.
    Sudore RL, Fried TR. Redefining the “planning” in advance care planning: preparing for end-of-life decision making. Ann Intern Med. 2010;153(4):256–61.  https://doi.org/10.7326/0003-4819-153-4-201008170-00008.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Sudore RL, Knight SJ, McMahan RD, et al. A novel website to prepare diverse older adults for decision making and advance care planning: a pilot study. J Pain Symptom Manag. 2014;47(4):674–86.  https://doi.org/10.1016/j.jpainsymman.2013.05.023.CrossRefGoogle Scholar
  12. 12.
    • Advance Care Planning: Conversations Matter - My Health AlbertaAlberta Health Services. Alberta. Canada. https://myhealth.alberta.ca/Alberta/Pages/advance-care-planning-conversation-matters.aspx. Last accessed 10 Jan 2018. On-line resource to explain ACP process.
  13. 13.
    El-Jawahri A, Mitchell S, et al. A randomized controlled trial of a CPR and intubation video decision support tool for hospitalized patients. J Gen Intern Med. 30(8):1071–80.Google Scholar
  14. 14.
    • Yeh J, Cheng J, et al. Using a question prompt list As a communication aid in advanced cancer. Care J Oncol. 2014;10(3):E137–42.Google Scholar
  15. 15.
    • Dunlay S, Strand J. How to discuss goals of care with patients. Trends Cardiovasc Med. 2016;26(1):36–43. Good review on GCD discussions, limitations, and approaches to ACP. CrossRefPubMedGoogle Scholar
  16. 16.
    You J, Fowler R, Hedland D, On behalf of the Canadian Researchers at the End of Life Network (CARENET). Just ask: discussing goals of care with patients in hospital with serious illness. CMAJ. 2014;186(6):425–32.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    • Kim DJ, Choi MS. Life-sustaining treatment and palliative care in patients with liver cirrhosis—legal, ethical, and practical issues. Clin Mol Hepatol. 2017;23(2):115–22 Insight into levels of care appropriate at various stages of cirrhosis care and when to involve palliative services.  https://doi.org/10.3350/cmh.2017.0018.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Valery P, Powell E e a. Systematic review: unmet supportive care needs in people diagnosed with chronic liver disease. BMJ Open. 2015;5(4):e007451.  https://doi.org/10.1136/bmjopen-2014-007451.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Volk ML, Fisher N, Fontana RJ. Patient knowledge about disease self-management in cirrhosis. Am J Gastroenterol. 2013;108(3):302–5.  https://doi.org/10.1038/ajg.2012.214.CrossRefPubMedGoogle Scholar
  20. 20.
    Stein MD, Maksad J, Clarke J. Hepatitis C disease among injection drug users: knowledge, perceived risk and willingness to receive treatment. Drug Alcohol Depend. 2001;61(3):211–5.  https://doi.org/10.1016/S0376-8716(00)00144-7.CrossRefPubMedGoogle Scholar
  21. 21.
    Tamayo-Velazquez M, Simón-Lorda P, et al. Interventions to promote the use of advance directives: an overview of systematic reviews. Patient Educ Couns. 2010;80(1):10–20.  https://doi.org/10.1016/j.pec.2009.09.027.CrossRefPubMedGoogle Scholar
  22. 22.
    US Department of Health and Human Services. Advanced Directives and Advance Care Planning. http://aspe.hhs.gov/daltcp/reports/2008/ADCongRpt.htm. Accessed 20 Dec 2017.
  23. 23.
    • Walling A, Ahluwalia S, et al. Palliative care quality indicators for patients with end-stage liver disease due to cirrhosis. Asch Dig Dis Sci. 2017;62:84–92. Updated panel review of evidence-based quality indicators for when ACP discussions should be undertaken, and comments on which QI have evidence based on symptom management. CrossRefPubMedGoogle Scholar
  24. 24.
    Karvellas C, Bagshaw SM. Advances in management and prognostication in critically ill cirrhotic patients. Curr Opin Crit Care. 2014;20(2):210–7.  https://doi.org/10.1097/MCC.0000000000000067.CrossRefPubMedGoogle Scholar
  25. 25.
    • PA G, Sinclair CT. Palliative medicine review: Prognostication. J Palliat Med. 2008;11:84–103. Review on prognostication. CrossRefGoogle Scholar
  26. 26.
    Zibelman M, Xiang Q, Muchka S, Nickoloff S, Marks S. Assessing prognostic documentation and accuracy among palliative care clinicians. J Palliat Med. 2014;17(5):521–6.  https://doi.org/10.1089/jpm.2013.0454.CrossRefPubMedGoogle Scholar
  27. 27.
    Mendis R, Soo WK, Zannino D, Michael N, Spruyt O. Multidisciplinary Prognostication Using the Palliative Prognostic Score in an Australian Cancer Center. Palliat Care: Res Treat. 2015:7–14.Google Scholar
  28. 28.
    Bruggeman A, Heavey BS, et al. Lack of documentation of evidence-based prognostication in cancer patients by In-patient palliative care consultants. J Palliat Med. 2015;18(4):382–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Patidar KR, Thacker LR, et al. Symptom domain groups of the patient-reported outcomes measurement information system tools independently predict hospitalizations and re-hospitalizations in cirrhosis. Dig Dis Sci. 2017;62(5):1173–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Mamede S, Schmidt H. The twin traps of overtreatment and therapeutic nihilism in clinical practice. Med Educ. 2014;48(1):34–43.  https://doi.org/10.1111/medu.12264.CrossRefPubMedGoogle Scholar
  31. 31.
    Cox-North P. Issues in the end-stage liver disease patient for which palliative care could be helpful CLD on line palliative supplement. Clin Liver Dis. 2015;6(2):33–6.  https://doi.org/10.1002/cld.492.CrossRefGoogle Scholar
  32. 32.
    •• James J, Liou I. Comprehensive care of patients with chronic liver disease. Med Clin N Am. 2015;99:913–33. Review of liver care, including medications for symptoms, symptom burden, prognostication scoring, and involvement of palliative care. CrossRefPubMedGoogle Scholar
  33. 33.
    Hansen L, Leo M, et al. Symptom distress in patients with end-stage liver disease toward the end of life. Gastroenterol Nurs. 2015;38(3):201–10.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Davison R, Sheerin NS. Prognosis and management of chronic kidney disease (CKD) at the end of life. Postgrad Med J. 2014;90(1060):98–105.  https://doi.org/10.1136/postgradmedj-2013-132195.CrossRefPubMedGoogle Scholar
  35. 35.
    Conservative Kidney Management, Alberta Canada. http://www.ckmcare.com/AboutPathwayPages. Last accessed 14 Jan 2018.
  36. 36.
    Morton R, Webster A, et al. Conservative management and end-of-life care in an Australian cohort with ESRD. Clin J Am Assoc Nephrol. 2016;11(12):2195–203.CrossRefGoogle Scholar
  37. 37.
    Lai JC. Defining the threshold for too sick for transplant. Curr Opin Organ Transplant. April 2016;21(2):127–32.  https://doi.org/10.1097/MOT.0000000000000286.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Fischberg, Bull J, for the AAHPM Choosing Wisely Task Force, et al. Five things physicians and patients should question in hospice and palliative medicine. J Pain Symptom Manag. 2013;45(3):595–605.CrossRefGoogle Scholar
  39. 39.
    Walling A, Schreibeis-Baum M, et al. Proactive case finding to improve concurrently curative and palliative care in patients with end-stage liver disease. J Palliat Med. 2015;18(4):378–81.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care in patients with metastatic non-small cell lung cancer. N Engl J Med. 2010;363(8):733–42.  https://doi.org/10.1056/NEJMoa1000678.CrossRefPubMedGoogle Scholar
  41. 41.
    Yoong J, Park ER, Greer JA, Jackson VA, Gallagher ER, Pirl WF, et al. Early palliative care in advanced lung cancer: a qualitative study. JAMA Intern Med. 2013;173(4):283–90.  https://doi.org/10.1001/jamainternmed.2013.1874.CrossRefPubMedGoogle Scholar
  42. 42.
    Gade G, Venohr I, Conner D, McGrady K, Beane J, Richardson RH, et al. Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med. 2008;11(2):180–90.  https://doi.org/10.1089/jpm.2007.0055.CrossRefPubMedGoogle Scholar
  43. 43.
    Casarett D, Pickard A, Bailey FA, Ritchie C, Furman C, Rosenfeld K, et al. Do palliative consultations improve patient outcomes? J Am Geriatr Soc. 2008;56(4):593–9.  https://doi.org/10.1111/j.1532-5415.2007.01610.x.CrossRefPubMedGoogle Scholar
  44. 44.
    Fried TR, Bradley EH, O'Leary J. Prognosis communication in serious illness: perceptions of older patients, caregivers, and clinicians. J Am Geriatr Soc. 2003;51(10):1398–403.  https://doi.org/10.1046/j.1532-5415.2003.51457.x.CrossRefPubMedGoogle Scholar
  45. 45.
    Meredith C, Symonds P, et al. Information needs of cancer patients in west Scotland: cross sectional survey of patients’ views. Br Med J. 1996;313(7059):724–6.  https://doi.org/10.1136/bmj.313.7059.724.CrossRefGoogle Scholar
  46. 46.
    Tierney WM, Dexter PR, al e. The effect of discussions about advance directives on patients’ satisfaction with primary care. J Gen Intern Med. 2001;16(1):32–40.PubMedPubMedCentralGoogle Scholar
  47. 47.
    •• Dingfield LE, Kayser JB. Integrating advance care planning into practice. Chest. 2017;151(6):1387–93. Key: Review outlining important factors in integrating ACP into practice in a non-cancer setting. Google Scholar
  48. 48.
    McPherson S, Lucey MR, Moriarty KJ. Decompensated alcohol related liver disease: acute management. BMJ. 2016;352:i124.CrossRefPubMedGoogle Scholar
  49. 49.
    • Facilitating Advance Care Planning: An Inter-professional Educational Program Curriculum Materials. http://www.advancecareplanning.ca/wp-content/uploads/2015/10/acp-curriculum-module_2008.pdf. Last accessed 8 Jan 2018. Key resources for ACP education for patients and practitioners.
  50. 50.
    Prepare Program. https://prepareforyourcare.org/prepare/0-1-1. Last accessed 8 Jan 2018.
  51. 51.
    Sudore A, Le GM, et al. The advance care planning PREPARE study among older Veterans with serious and chronic illness: study protocol for a randomized controlled trial. Rebecca Trials. 2015;16(1):570.  https://doi.org/10.1186/s13063-015-1055-9.CrossRefPubMedGoogle Scholar
  52. 52.
    Ripoll C, Genesc J, et al. Re-bleeding prophylaxis improves outcomes in patients with hepatocellular carcinoma: a multicenter case-control study. Hepatology. 2013;58(6):2079–88.  https://doi.org/10.1002/hep.26629.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Medicine, Division of Internal Medicine, 2D4.48, WCM CenterUniversity of AlbertaEdmontonCanada
  2. 2.Department of Oncology, Division of Palliative CareUniversity of Alberta and Covenant HealthEdmontonCanada
  3. 3.Cirrhosis Care Clinic, Department of Medicine, Division of GastroenterologyUniversity of AlbertaEdmontonCanada

Personalised recommendations