Barriers to palliative care in hepatocellular carcinoma: A review of the literature

Publisher:
Wiley
Publication Type:
Journal Article
Citation:
Journal of Gastroenterology and Hepatology, 2023, 38, (7), pp. 1047-1055
Issue Date:
2023-07
Full metadata record
Hepatocellular carcinoma HCC is a deadly and burdensome form of liver cancer with an increasing global prevalence Its course is unpredictable as it frequently occurs in the context of underlying end stage liver disease and the associated symptoms and adverse effects of treatment cause severe suffering for patients Palliative care PC is a medical specialty that addresses the physical emotional and spiritual needs of patients and their carers in the context of life limiting illness In other cancers a growing body of evidence has demonstrated that the early introduction of PC at diagnosis improves patient and carer outcomes Despite this the integration of palliative care at the diagnosis of HCC remains suboptimal as patients usually receive PC only at the very terminal phase of their disease even when diagnosed early Significant barriers to the uptake of palliative care in the treatment algorithm of hepatocellular carcinoma fall under four main themes data limitations disease clinician and patient factors Barriers relating to data limitations mainly encapsulated the risk of bias inherent in published work in the field of PC Clinician reported barriers related to negative attitudes towards PC and a lack of time for PC discussions Barriers related to the disease align with prognostic uncertainty due to the unpredictable course of HCC Significantly there exists a paucity of evidence exploring patient perceived barriers to timely PC implementation in HCC Given that patients are often the underrepresented stakeholder in the delivery of PC future research should explore the patient perspective in adequately designed qualitative studies as the first step
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