Palliative Care and Hospice Interventions in Decompensated Cirrhosis and Hepatocellular Carcinoma: A Rapid Review of Literature.

Autor:	Mudumbi SK; 1 Center for Palliative and Supportive Care, University of Alabama at Birmingham , Birmingham, Alabama.; 2 Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.; 3 Health Services and Outcomes Research Post-Doctoral Training Program, University of Alabama at Birmingham , Birmingham, Alabama., Bourgeois CE; 4 University of Alabama at Birmingham School of Medicine , Birmingham, Alabama., Hoppman NA; 5 Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama., Smith CH; 6 Lister Hill Library of the Health Sciences, University of Alabama at Birmingham , Birmingham, Alabama., Verma M; 7 Division of Hepatology, Department of Transplantation, Einstein Healthcare Network , Philadelphia, Pennsylvania., Bakitas MA; 1 Center for Palliative and Supportive Care, University of Alabama at Birmingham , Birmingham, Alabama.; 8 University of Alabama at Birmingham School of Nursing , Birmingham, Alabama., Brown CJ; 2 Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.; 9 Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education and Clinical Center , Birmingham, Alabama.; 10 Comprehensive Center for Healthy Aging, University of Alabama at Birmingham , Birmingham, Alabama., Markland AD; 2 Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.; 9 Department of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education and Clinical Center , Birmingham, Alabama.; 10 Comprehensive Center for Healthy Aging, University of Alabama at Birmingham , Birmingham, Alabama.
Jazyk:	angličtina
Zdroj:	Journal of palliative medicine [J Palliat Med] 2018 Aug; Vol. 21 (8), pp. 1177-1184. Date of Electronic Publication: 2018 Apr 26.
DOI:	10.1089/jpm.2017.0656
Abstrakt:	Background: Patients with decompensated cirrhosis (DC) and/or hepatocellular carcinoma (HCC) have a high symptom burden and mortality and may benefit from palliative care (PC) and hospice interventions. Objective: Our aim was to search published literature to determine the impact of PC and hospice interventions for patients with DC/HCC. Methods: We searched electronic databases for adults with DC/HCC who received PC, using a rapid review methodology. Data were extracted for study design, participant and intervention characteristics, and three main groups of outcomes: healthcare resource utilization (HRU), end-of-life care (EOLC), and patient-reported outcomes. Results: Of 2466 results, eight were included in final results. There were six retrospective cohort studies, one prospective cohort, and one quality improvement study. Five of eight studies had a high risk of bias and seven studied patients with HCC. A majority found a reduction in HRU (total cost of hospitalization, number of emergency department visits, hospital, and critical care admissions). Some studies found an impact on EOLC, including location of death (less likely to die in the hospital) and resuscitation (less likely to have resuscitation). One study evaluated survival and found hospice had no impact and another showed improvement of symptom burden. Conclusion: Studies included suggest that PC and hospice interventions in patients with DC/HCC reduce HRU, impact EOLC, and improve symptoms. Given the few number of studies, heterogeneity of interventions and outcomes, and high risk of bias, further high-quality research is needed on PC and hospice interventions with a greater focus on DC.
Databáze:	MEDLINE
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