AGA issues new guidance on palliative care management in cirrhosis

The American Gastroenterological Association published a new clinical practice update on palliative care management in patients with cirrhosis.

“Associated with a high burden of physical and psychological symptoms even in the compensated state, the quality of life of patients [with cirrhosis] with worsening disease severity parallels that of patients with advanced cancer,” Puneeta Tandon, MD, MSc, division of gastroenterology at the University of Alberta in Alberta, Canada, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Despite this high symptom burden and chance for acute unexpected deteriorations in their disease course, rates of advance care planning and goals of care directives remain low, symptom management is suboptimally addressed and specialty palliative care and hospice referrals occur infrequently and late in the course of the disease.”

Tandon and colleagues developed 10 best practice advice statements addressing the key issues in palliative care including the need for broadened use, in-depth quality of life assessments and optimized referrals.

Included among the guidance for palliative care management in patients with cirrhosis from the AGA are:

• Palliative care should be provided to any patient with an advanced chronic illness regardless of transplant candidacy or prognosis alone.
• Delivery of palliative care may be done by health care providers of any specialty and should include specialist collaboration.
• Patients with cirrhosis should be assessed for physical symptoms, psychological symptoms, social symptoms and spiritual symptoms.
• Providers should evaluate caregiver support and caregiver needs as part of routine care assessments.
• In-depth communication for advanced care planning, goals of care conversation and prognostic awareness are beneficial for both patient and caregiver.

“During the last decade, there has been an increasing recognition of unmet needs for palliative care for patients with cirrhosis,” Tandon and colleagues added. “This has been associated with a recent surge in funding and publications addressing advanced care planning and the impact of palliative care on symptoms and health-related quality of life.”