Hospice care for end stage liver disease in the United States

ABSTRACT

Introduction

Patients with end-stage liver disease (ESLD) have impaired physical, psychological, and social functions, which can diminish patient quality of life, burden family caregivers, and increase health-care utilization. For those with a life expectancy of less than six months, these impairments and their downstream effects can be addressed effectively through high-quality hospice care, delivered by multidisciplinary teams and focused on the physical, emotional, social, and spiritual wellbeing of patients and caregivers, with a goal of improving quality of life.

Areas Covered

In this review, we examine the evidence supporting hospice for ESLD, we compare this evidence to that supporting hospice more broadly, and we identify potential criteria that may be useful in determining hospice appropriateness.

Expert Opinion

Despite the potential for hospice to improve care for those at the end of life, it is underutilized for patients with ESLD. Increasing the appropriate utilization of hospice for ESLD requires a better understanding of patient eligibility, which can be based on predictors of high short-term mortality and liver transplant ineligibility. Such hospice criteria should be data-driven and should accommodate the uncertainty faced by patients and physicians.

KEYWORDS:

• End-stage liver disease
• hospice
• liver transplant
• palliative care
• prognosis

Article highlights

• Patients with ESLD near the end of life have numerous physical, emotional, social, and spiritual concerns that can be addressed through high-quality hospice care.

• Current liver-specific Medicare hospice eligibility guidelines rely on dated, non-data-driven criteria.

• Future hospice criteria for ESLD should be based on accurate, contemporary prognostic markers, and liver transplant eligibility.

• For patients with ESLD near the end of life, hospice is underutilized, and several barriers exist to increase timely hospice referrals.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was partly funded by the National Institutes of Health under award number K23DK109202. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.