Conditions

HOSPICE CARE FOR LIVER DISEASE PATIENTS

End-of-Life Care for Patients Suffering from Liver Disease

Symptoms experienced by patients with end-stage liver disease (ESLD) may be well known to a physician, but determining hospice eligibility can be difficult, especially for patients eligible for transplant. The primary care physician or nephrologist will look at the patient’s condition in his totality and at the following clinical indicators that the patient has end-stage Patients liver disease:

• Prothrombin time prolonged more than 5 seconds over control, or International Normalized Ratio (INR)>1.5
• Serum albumin
• Ascites, refractory to treatment or patient non-compliant
• Spontaneous bacterial peritonitis
• Hepatorenal syndrome (elevated creatinine and BUN with oliguria (<400ml/day) and urine sodium concentration
• Hepatic encephalopathy, refractory to treatment, or patient non-compliant
• Recurrent variceal bleeding, despite intensive therapy
• Progressive malnutrition
• Muscle wasting with reduced strength and endurance
• Continued active alcoholism (>80 gm ethanol/day)
• Hepatocellular carcinoma
• HBsAg (Hepatitis B) positivity
• Hepatitis C refractory to interferon treatment

We at Heart of Hope Hospice understand that some clinical information presented to the patient’s family may not be a great help in making a decision for hospice care.  Please, call us when you have any specific question regarding eligibility for hospice and the type of services we offer for patients with liver disease.

When it comes to information regarding eligibility for hospice care, it can be overwhelming for some families, for example some families may not know that a patient awaiting liver transplant may be under hospice care until a donor organ is procured. The patient will just be discharged from hospice care at that time.

Also, if a patient has kidney failure, is on hemodialysis but has other body system(s) who are failing, the patient can be under hospice care at the same time the patient is under hemodialysis.

Heart of Hope Hospice’s mission is to serve those in the end stages of liver disease, to relieve pain, control symptoms, improve quality of life and reduce anxiety for patients and their families. Only a doctor can make a clinical determination of end-stage liver disease life expectancy. However, look for these common signs that the disease has progressed to a point where all involved would likely benefit from hospice services.

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Signs it might be time for hospice

Considering the slow decline of a patient with liver disease, it can be difficult to determine when the time is right for hospice. In general, hospice patients are believed to have six months or less to live.

Not every patient with ESLD wants or is appropriate for a liver transplant. When symptoms become difficult to control and quality of life deteriorates, patients and their families and physicians should consider hospice.

When a patient is a not a candidate for a liver transplant or the patient’s transplant has failed and the patient is not eligible for, or refuses, another transplant, these are the typical signs that indicates the patient will benefit from Heart of Hope Hospice comfort measures/palliative care:

• Sudden or progressive loss of functional independence
• Weight loss or reduced appetite
• Inability to work
• Patient spends the majority of time sitting or lying in bed
• Confusion, cognitive impairment
• Abdominal distension
• Malaise
• Bowel dysfunction
• Breathing difficulties
• Itchy skin
• Restlessness
• Altered mood and behavior

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Benefits of Heart of Hope Hospice Care for Liver Disease Patients

The Heart of Hope Hospice team will evaluate the patient’s medical status and revise their care plan as the patient’s condition and symptoms change. The goal of hospice care for liver disease patients is to treat pain and other symptoms and relieve the physical and emotional stress to ensure the greatest level of comfort for our patients and their families.

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Pain Management – Heart of Hope Hospice Care team provides Comfort/palliative care which focuses on relieving pain and maintaining comfort.

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Symptom Control – The Heart of Hope Hospice Care team regularly assesses each patient’s condition and works with the hospice Medical Director to determine the most effective treatment and medication options to maximize symptom control.

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Coordinated care at every level – A plan of care is developed with the advice and consent of the patient’s physician, if available or Heart of Hope Hospice physician. The Heart of Hope Hospice Case Manager ensures that information flows between physicians, the visiting nurse, social worker and, at the patient’s request, clergy. In addition, Heart of Hope Hospice coordinates and supplies all medications, medical supplies and medical equipment related to the diagnosis to ensure patients have everything they need.

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Emotional and spiritual assistance – Heart of Hope Hospice has the resources to help patients maintain their emotional and spiritual well-being.

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