Nicholas Hoppmann, Marie Bakitas, Macy Stockdill, Jan DeNofrio, Victor Navarro, Manisha Verma
{"title":"晚期肝病的姑息治疗：肝病学和姑息治疗专家的经验。","authors":"Nicholas Hoppmann, Marie Bakitas, Macy Stockdill, Jan DeNofrio, Victor Navarro, Manisha Verma","doi":"10.1016/j.jpainsymman.2025.09.028","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>People with advanced liver disease (ALD) face progressive symptoms and may benefit from palliative care (PC); but optimal care models remain unknown.</p><p><strong>Objectives: </strong>To describe PC-trained hepatologists and board-certified PC specialists experiences with integrating PC into ALD care.</p><p><strong>Methods: </strong>We conducted an embedded qualitative evaluation study, within the 19-site, randomized PAL-LIVER comparative effectiveness trial, to understand clinicians' perspectives on providing integrated PC in ALD. Semi-structured interviews, conducted between March 23, 2020, and July 1, 2022, were transcribed verbatim, coded, and analyzed to generate themes about their experiences.</p><p><strong>Results: </strong>Clinicians (17=hepatologists; 15=PC providers) with mean age (SD) of 47.3 (8.8) years, 65.3% women, 78.1% White, 68.4% physicians, and 25% nurse practitioners; 43.7 % had been in practice ≤10 years. Shared themes included: 1) Cross-disciplinary primary PC and ALD education is central to PC integration; and 2) Providing PC takes time. Hepatologists unique themes were: 1) Navigating the intersection of primary and specialty PC, and 2) Increased awareness of caregivers' needs. PC specialists' unique themes were: 1) Misperceptions of PC, and 2) Characteristics of hepatology-palliative collaborations.</p><p><strong>Conclusions: </strong>Future PC implementation into routine ALD care will require cross-disciplinary education, adjustments to hepatologists clinical schedules to allocate time to assess and address patient and caregiver PC needs and to discern which patients are best managed by a trained hepatologist vs a PC specialist. On-going misperceptions about the purpose of PC were addressed and facilitated by interdisciplinary collaboration. Our results will guide future efforts to scale PC integration into routine ALD management.</p><p><strong>Clinicaltrials: </strong>gov NCT03540771.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Palliative Care for Advanced Liver Disease: Hepatology and Palliative Care Specialists Experiences.\",\"authors\":\"Nicholas Hoppmann, Marie Bakitas, Macy Stockdill, Jan DeNofrio, Victor Navarro, Manisha Verma\",\"doi\":\"10.1016/j.jpainsymman.2025.09.028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Context: </strong>People with advanced liver disease (ALD) face progressive symptoms and may benefit from palliative care (PC); but optimal care models remain unknown.</p><p><strong>Objectives: </strong>To describe PC-trained hepatologists and board-certified PC specialists experiences with integrating PC into ALD care.</p><p><strong>Methods: </strong>We conducted an embedded qualitative evaluation study, within the 19-site, randomized PAL-LIVER comparative effectiveness trial, to understand clinicians' perspectives on providing integrated PC in ALD. Semi-structured interviews, conducted between March 23, 2020, and July 1, 2022, were transcribed verbatim, coded, and analyzed to generate themes about their experiences.</p><p><strong>Results: </strong>Clinicians (17=hepatologists; 15=PC providers) with mean age (SD) of 47.3 (8.8) years, 65.3% women, 78.1% White, 68.4% physicians, and 25% nurse practitioners; 43.7 % had been in practice ≤10 years. Shared themes included: 1) Cross-disciplinary primary PC and ALD education is central to PC integration; and 2) Providing PC takes time. Hepatologists unique themes were: 1) Navigating the intersection of primary and specialty PC, and 2) Increased awareness of caregivers' needs. PC specialists' unique themes were: 1) Misperceptions of PC, and 2) Characteristics of hepatology-palliative collaborations.</p><p><strong>Conclusions: </strong>Future PC implementation into routine ALD care will require cross-disciplinary education, adjustments to hepatologists clinical schedules to allocate time to assess and address patient and caregiver PC needs and to discern which patients are best managed by a trained hepatologist vs a PC specialist. On-going misperceptions about the purpose of PC were addressed and facilitated by interdisciplinary collaboration. Our results will guide future efforts to scale PC integration into routine ALD management.</p><p><strong>Clinicaltrials: </strong>gov NCT03540771.</p>\",\"PeriodicalId\":16634,\"journal\":{\"name\":\"Journal of pain and symptom management\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-10-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of pain and symptom management\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jpainsymman.2025.09.028\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jpainsymman.2025.09.028","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Palliative Care for Advanced Liver Disease: Hepatology and Palliative Care Specialists Experiences.
Context: People with advanced liver disease (ALD) face progressive symptoms and may benefit from palliative care (PC); but optimal care models remain unknown.
Objectives: To describe PC-trained hepatologists and board-certified PC specialists experiences with integrating PC into ALD care.
Methods: We conducted an embedded qualitative evaluation study, within the 19-site, randomized PAL-LIVER comparative effectiveness trial, to understand clinicians' perspectives on providing integrated PC in ALD. Semi-structured interviews, conducted between March 23, 2020, and July 1, 2022, were transcribed verbatim, coded, and analyzed to generate themes about their experiences.
Results: Clinicians (17=hepatologists; 15=PC providers) with mean age (SD) of 47.3 (8.8) years, 65.3% women, 78.1% White, 68.4% physicians, and 25% nurse practitioners; 43.7 % had been in practice ≤10 years. Shared themes included: 1) Cross-disciplinary primary PC and ALD education is central to PC integration; and 2) Providing PC takes time. Hepatologists unique themes were: 1) Navigating the intersection of primary and specialty PC, and 2) Increased awareness of caregivers' needs. PC specialists' unique themes were: 1) Misperceptions of PC, and 2) Characteristics of hepatology-palliative collaborations.
Conclusions: Future PC implementation into routine ALD care will require cross-disciplinary education, adjustments to hepatologists clinical schedules to allocate time to assess and address patient and caregiver PC needs and to discern which patients are best managed by a trained hepatologist vs a PC specialist. On-going misperceptions about the purpose of PC were addressed and facilitated by interdisciplinary collaboration. Our results will guide future efforts to scale PC integration into routine ALD management.
期刊介绍：
The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.
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