Amanda Brisebois
University of Alberta, Canada
Title: What is the Role of Palliative Care Principles in Cirrhosis Care: Three Initiatives
Biography
Biography: Amanda Brisebois
Abstract
Cirrhosis is a chronic progressive illness that affects from 4.5% to 9.5% of the population, and an estimated 50 million adults worldwide. Alcohol, NASH and viral hepatitis are reported to be the most common causative factors. HCV is carried by an estimated 170 million people worldwide and approximately 3-4 million new cases occur a year. In 2001, cirrhosis ranked as the 14th and 10th leading cause of death in the world and in developed countries, respectively1. Projections suggest that growth in the cirrhosis population is rapid, and is expected to rise to the 12th leading cause of death worldwide in 2020. Despite high mortality rates, frequent hospitalizations, low rates of advance care planning, and high symptom burden, discussions surrounding these issues are infrequent. In an Edmonton, Alberta, Canada Cirrhosis Care Clinic, only 15% of patients have ACP discussions and resulting goals of care designations (GCD), few have clear documentation and management of symptom burden, and Palliative Care specialists are infrequently involved. An outpatient non-cancer Palliative Care clinic, has been in operation since 2012, and data has been collected for the 45 patients seen with cirrhosis. Retrospective analysis of local inpatient experience has also been published. Within these settings, a multi-disciplinary group at the University Hospital in Edmonton has undertaken multiple research and clinical initiatives, to heighten the awareness of palliative principles applying to the care continuum of patients with cirrhosis. Three ongoing initiatives will be described: 1) Work expanding knowledge translation and utilization with respect to Advance Care Planning in cirrhosis patients. 2) Outpatient non-cancer palliative clinic outcomes in cirrhosis patients describing symptom burden, success of symptom management, ACP utilization and issues in transitions of care. 3) Burden of pain in the cirrhosis population, difficulties with therapy, and utility of non-pharmacologic therapies, including an ongoing study in mindfulness intervention. For all initiatives, educational pamphlets have been created and testing is underway. The multi-disciplinary group is involved in local, Canadian and international education regarding the integration of palliative principles into regular cirrhosis care.