Benefit of Early Palliative Care Intervention in End-Stage Liver Disease Patients Awaiting Liver Transplantation

J Pain Symptom Manage. 2015 Dec;50(6):882-6.e2. doi: 10.1016/j.jpainsymman.2015.07.014. Epub 2015 Aug 22.


Background: Patients with end-stage liver disease have a predictable and progressive decline in their quality of life because of physical symptoms and psychological distress. Early palliative care intervention (EPCI) correlates with better symptom control and mood. We aimed to improve symptomatology and mood in liver transplant candidates by implementing a longitudinal multidisciplinary EPCI.

Measures: Depression level and symptom burden were assessed with Center for Epidemiological Studies Depression Scale and a modified liver-specific Edmonton Symptom Assessment System scale.

Intervention: All patients referred for liver transplant evaluation between July 2013 and May 2014 were scheduled for EPCI.

Outcomes: After EPCI, 50% of moderate-to-severe symptoms improved (P < 0.05), and 43% of patients showed improvement in clinically significant depressive symptoms (P = 0.003). Notably, patients with more symptoms showed a greater improvement in Center for Epidemiological Studies Depression Scale scores (P = 0.001).

Conclusions/lessons learned: Implementation of EPCI improved symptom burden and mood in end-stage liver disease patients awaiting transplant.

Keywords: CES-D; ESAS; End-stage liver disease; cirrhosis; early palliative care intervention; liver transplant.

MeSH terms

  • Affect
  • Cost of Illness
  • Depression
  • End Stage Liver Disease / psychology
  • End Stage Liver Disease / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Palliative Care / methods*
  • Preoperative Care / methods*
  • Psychiatric Status Rating Scales
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome