Massimo Iavarone, Lorenzo Canova, Eleonora Alimenti, Alessio Aghemo, Diego Taveggia, Gino Gobber, Giuseppe Cabibbo, Simone Veronese, Vincenza Calvaruso, Luciano Orsi, Paolo Caraceni, Pietro Lampertico
{"title":"Palliative care in patients with hepatocellular carcinoma: Results from a survey among hepatologists and palliative care physicians.","authors":"Massimo Iavarone, Lorenzo Canova, Eleonora Alimenti, Alessio Aghemo, Diego Taveggia, Gino Gobber, Giuseppe Cabibbo, Simone Veronese, Vincenza Calvaruso, Luciano Orsi, Paolo Caraceni, Pietro Lampertico","doi":"10.1177/02692163241269794","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Delays and limitations of palliative care in patients with liver transplantation-<i>ineligible</i> end-stage hepatocellular carcinoma according to Barcelona Clinic Liver Cancer staging system may be explained by different perceptions between hepatologists and palliative care physicians in the absence of shared guidelines.</p><p><strong>Aim: </strong>To assess physicians' attitudes toward palliative care in end-stage hepatocellular carcinoma and to understand what the obstacles are to more effective management and co-shared between palliative care physicians and hepatologists.</p><p><strong>Design: </strong>Members of the Italian Association for the Study of Liver Disease and the Italian Society of Palliative Care were invited to a web-based survey to investigate practical management attitude for patients with liver transplant-<i>ineligible</i> end-stage hepatocellular carcinoma.</p><p><strong>Participants: </strong>Physician members of the of the two associations, representing several hospitals and services in the country.</p><p><strong>Results: </strong>Ninety-seven hepatologists and 70 palliative care physicians completed the survey: >80% regularly follow 1-19 patients; 58% of hepatologists collaborate with palliative care physicians in the management of patients, 55% of palliative care physicians take care of patients without the aid of hepatologists. Management of cirrhosis differed significantly between the two groups in terms of prescription of albumin, esophagogastroduodenoscopy, anti-viral treatment, anticoagulation, indication to paracentesis and management of encephalopathy. Full-dose acetaminophen is widely used among hepatologists, while opioids are commonly used by both categories, at full dosage, regardless of liver function.</p><p><strong>Conclusions: </strong>This survey highlights significant differences in the approach to patients with liver transplantation-<i>ineligible</i> end-stage hepatocellular carcinoma, reinforcing the need for shared guidelines and further studies on palliative care in the setting.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1033-1041"},"PeriodicalIF":3.6000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Palliative Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/02692163241269794","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/28 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Delays and limitations of palliative care in patients with liver transplantation-ineligible end-stage hepatocellular carcinoma according to Barcelona Clinic Liver Cancer staging system may be explained by different perceptions between hepatologists and palliative care physicians in the absence of shared guidelines.
Aim: To assess physicians' attitudes toward palliative care in end-stage hepatocellular carcinoma and to understand what the obstacles are to more effective management and co-shared between palliative care physicians and hepatologists.
Design: Members of the Italian Association for the Study of Liver Disease and the Italian Society of Palliative Care were invited to a web-based survey to investigate practical management attitude for patients with liver transplant-ineligible end-stage hepatocellular carcinoma.
Participants: Physician members of the of the two associations, representing several hospitals and services in the country.
Results: Ninety-seven hepatologists and 70 palliative care physicians completed the survey: >80% regularly follow 1-19 patients; 58% of hepatologists collaborate with palliative care physicians in the management of patients, 55% of palliative care physicians take care of patients without the aid of hepatologists. Management of cirrhosis differed significantly between the two groups in terms of prescription of albumin, esophagogastroduodenoscopy, anti-viral treatment, anticoagulation, indication to paracentesis and management of encephalopathy. Full-dose acetaminophen is widely used among hepatologists, while opioids are commonly used by both categories, at full dosage, regardless of liver function.
Conclusions: This survey highlights significant differences in the approach to patients with liver transplantation-ineligible end-stage hepatocellular carcinoma, reinforcing the need for shared guidelines and further studies on palliative care in the setting.
期刊介绍：
Palliative Medicine is a highly ranked, peer reviewed scholarly journal dedicated to improving knowledge and clinical practice in the palliative care of patients with far advanced disease. This outstanding journal features editorials, original papers, review articles, case reports, correspondence and book reviews. Essential reading for all members of the palliative care team. This journal is a member of the Committee on Publication Ethics (COPE).
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