What Are the Causes and Complications of Chronic Liver Disease and What Is the Evidence for Palliative Care Delivery to Those Affected by It?

Chronic liver disease (CLD) refers to a group of conditions that affect the liver and include cirrhosis, or replacement of functional liver with scarring, and hepatocellular carcinoma (HCC), the most common primary liver cancer. CLD is a major cause of morbidity and mortality worldwide and arises from a variety of conditions including viral hepatitis, chronic alcohol consumption, fatty liver disease associated with metabolic syndrome, autoimmune diseases, genetic disorders, and injury from ingestion of drugs or toxins. Complications of liver disease arise from the onset of portal hypertension and liver dysfunction. These complications have important implications for an individual’s prognosis, disease course, and symptom burden. Liver transplantation is the only curative therapy available for CLD, however many people facing CLD are ineligible or are unable to receive a transplant because of organ scarcity. There is a small but growing body of evidence to support expanded palliative care access for patients and families affected by CLD. The focus of ongoing research includes the role of advance care planning, primary palliative care delivered by hepatology teams, specialty-level palliative care in the inpatient and outpatient settings, and hospice care.