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Integrating Palliative Principles into Cirrhosis Care: The Effect of Hepatic Encephalopathy

  • Michael Ney
  • Amanda Brisebois
  • Puneeta Tandon
Chapter

Abstract

The integration of palliative principles into the management of patients with cirrhosis is a vital, yet often overlooked, component of cirrhosis care. With a focus on symptom control and advance care planning (ACP) discussions, the integration of care using palliative care principles enhances health-related quality of life, decreases healthcare utilization, and improves patient and family satisfaction. The routine use of palliative principles has the potential to optimize effective and comprehensive management of all patients with cirrhosis. These principles have particular relevance in patients with hepatic encephalopathy (HE), with several points of intersection. Most notably, (i) HE itself is perhaps the most debilitating symptom of cirrhosis, requiring early detection and intensive symptom management; (ii) medications given to control other cirrhosis-associated symptoms, such as pain killers, anxiolytics, neuroleptics, benzodiazepines, and antidepressants, may precipitate HE, necessitating dose reduction or avoidance; (iii) the cognitive impairment that defines HE complicates ACP and is a major reason supporting early ACP discussions; and (iv) HE increases caregiver burnout. This chapter outlines the role of integrating palliative principles into cirrhosis care and more specifically the care of patients with HE. We provide an overview of medication management considering the risk for HE and finally we discuss brief strategies for supporting caregivers of patients with cirrhosis, vital members of the healthcare team who are often underappreciated and overworked, at the expense of their own well-being.

Keywords

Palliative care Caregiver burden De-prescribing Symptom management Quality of life 

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of GastroenterologyUniversity of AlbertaEdmontonCanada
  2. 2.Division of Palliative Care and General Internal MedicineUniversity of AlbertaEdmontonCanada
  3. 3.Cirrhosis Care Clinic, Division of GastroenterologyUniversity of AlbertaEdmontonCanada

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