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Hansen L, Chang MF, Hiatt S, Dieckmann NF, Lee CS. Distinct Longitudinal Trajectories of Symptom Burden Predict Clinical Outcomes in End-Stage Liver Disease. Clin Transl Gastroenterol 2024; 15:e00728. [PMID: 38920299 PMCID: PMC11346848 DOI: 10.14309/ctg.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Little has been reported about the clinical relevance and trajectories of symptoms in end-stage liver disease (ESLD). The purpose of this prospective study was to identify trajectories of change in symptom burden over the course of 12 months in adults with ESLD. METHODS Patients were recruited from hepatology clinics at 2 healthcare systems. Validated measures were used to assess physical and psychological symptoms. Latent growth mixture modeling and survival and growth modeling were used to analyze the survey data. RESULTS Data were available for 192 patients (mean age 56.5 ± 11.1 years, 64.1% male, mean Model for ESLD (MELD) 3.0 19.2 ± 5.1, ethyl alcohol as primary etiology 33.9%, ascites 88.5%, encephalopathy 70.8%); there were 38 deaths and 39 liver transplantations over 12 months. Two symptom trajectories were identified: 62 patients (32.3%) had high and unmitigated symptoms, and 130 (67.7%) had lower and improving symptoms. Patients with high and unmitigated symptoms had twice the hazard of all-cause mortality (subhazard ratio 2.53, 95% confidence interval: 1.32-4.83) and had worse physical ( P < 0.001) and mental quality of life ( P = 0.012) compared with patients with lower and improving symptoms. Symptom trajectories were not associated with MELD 3.0 scores ( P = 0.395). Female sex, social support, and level of religiosity were significant predictors of symptom trajectories ( P < 0.05 for all). DISCUSSION There seems to be 2 distinct phenotypes of symptom experience in patients with ESLD that is independent of disease severity and associated with sex, social support, religiosity, and mortality. Identifying patients with high symptom burden can help optimize their care.
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Affiliation(s)
- Lissi Hansen
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Michael F. Chang
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- VA Portland Health Care System, Portland, Oregon, USA
| | - Shirin Hiatt
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Nathan F. Dieckmann
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Christopher S. Lee
- Boston College William F Connell School of Nursing, Chestnut Hill, Massachusetts, USA
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Hansen L, Chang MF, Hiatt S, Dieckmann NF, Lee CS. Informal Family Care Partner Well-Being Is Diminished in End-Stage Liver Disease. Nurs Res 2024; 73:E202-E211. [PMID: 38526959 PMCID: PMC11192616 DOI: 10.1097/nnr.0000000000000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND Chronic liver disease is a significant global neglected public health problem. End-stage liver disease is associated with substantial symptom complexity, disability, and care needs that require assistance from informal family care partners. Research on these care partners' caregiver burden or strain, symptoms, and quality of life is sparse and has not focused on these variables as co-occurring or in the context of the quality of the relationship care partners have with the patients. OBJECTIVES The purpose of this study was to provide a collective presentation of patterns and determinants of well-being as measured by caregiver strain, depression, sleep, and quality of life in a cohort of informal family care partners for adult outpatients with end-stage liver disease. METHODS Care partners (aged >18 years) were recruited from two liver clinics within two tertiary healthcare systems and invited to complete a cross-sectional survey. They completed the Multidimensional Caregiver Strain Index, Patient Health Questionnaire, Pittsburgh Sleep Quality Index, Short Form Health Survey, and Mutuality Scale. Descriptive statistics and latent class mixture modeling were used to analyze these data. RESULTS The sample was predominantly female and White. The well-being of care partners was diminished. Three distinct classes of well-being were identified: mildly diminished (53.2%), moderately diminished (39.0%), and severely diminished (7.8%). Those at a greater risk of worse well-being were younger and spouses and had poorer relationship quality with the patients. DISCUSSION To improve the well-being of care partners in moderately and severely diminished classes, assessing and addressing caregiver strain and co-occurring symptoms is essential. Addressing the strain and symptoms has the potential to maintain or optimize care partners' ability to provide care to patients. Future researchers should include longitudinal and dyadic studies to examine how patients' disease progression and symptoms may affect family care partners' well-being and vice versa.
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Hansen L, Chang MF, Hiatt S, Dieckmann NF, Mitra A, Lyons KS, Lee CS. Symptom Classes in Decompensated Liver Disease. Clin Gastroenterol Hepatol 2022; 20:2551-2557.e1. [PMID: 34813941 PMCID: PMC9120261 DOI: 10.1016/j.cgh.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/26/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with decompensated liver disease have been categorized by disease severity. This analysis sought to classify patients with end-stage liver disease based on symptoms rather than disease state and to identify distinct severity classes of physical and psychological symptoms. METHODS Patients with a model for end-stage liver disease-sodium score of 15 or higher were recruited from liver clinics in 2 health care organizations. They completed the Condensed Memorial Symptom Assessment Scale, Revised Ways of Coping Checklist, Patient Health Questionnaire, Life Orientation Test-Revised, and the Short-Form Health Survey. Cross-sectional data were analyzed using latent class mixture modeling. RESULTS The sample (N = 191; age, 56.6 ± 11.1 y; 33.5% ETOH; 28.3% nonalcoholic fatty liver disease; 13.1% autoimmune/primary biliary cholangitis/primary sclerosing cholangitis) was predominantly male (64.2%), Child-Turcotte-Pugh class C (49.5%), with an average model for end-stage liver disease-sodium score of 18.7 ± 4.9. Three distinct classes of symptoms were identified, as follows: mild (26.7%), moderate (41.4%), or severe (31.9%) symptoms. Symptom classes were independent of disease severity and demographic characteristics, except age. All Condensed Memorial Symptom Assessment Scale symptoms and Patient Health Questionnaire scores were significantly different across the 3 classes (P < .05). The symptom classes also differed significantly in physical and mental quality of life, optimism, and avoidance coping behaviors (all P < .001). CONCLUSIONS Patient-reported symptom severity occurred independent of disease severity, contrary to common assumptions. Focusing on the moderate and severe symptom classes as well as patient history of end-stage liver disease complications may enhance providers' ability to improve symptom management for this population.
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Affiliation(s)
- Lissi Hansen
- School of Nursing, Oregon Health and Science University, Portland, Oregon.
| | - Michael F Chang
- Gastroenterology and Hepatology, VA Portland Health Care System, Portland, Oregon
| | - Shirin Hiatt
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Arnab Mitra
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts
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Symptom Frequency and Distress Underestimated in Decompensated Cirrhosis. Dig Dis Sci 2022; 67:4234-4242. [PMID: 34448980 PMCID: PMC8882195 DOI: 10.1007/s10620-021-07216-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies assessing multiple symptoms and the distress of these symptoms in decompensated cirrhosis are lacking. AIMS The aims of this study were to assess symptom prevalence and distress among patients with decompensated cirrhosis and to describe medical management of the most prevalent symptoms. METHODS Patients were recruited from hepatology clinics within two health-care systems. Eligibility criteria included a model for end-stage liver disease (MELD-Na) score ≥15. Patients completed the Condensed Memorial Symptom Assessment Scale and Patient Health Questionnaire. Comparative statistics were used to analyze the cross-sectional survey data. RESULTS Of the sample (n = 146), most patients were Child-Turcotte-Pugh (CTP) class B (49.7%) and C (46.2%). Mean age was 56.5 years, 65.1% were male, and 88.4% were white. Average MELD-Na score was 19.1 ± 4.5. The most prevalent symptoms were lack of energy and feeling drowsy while the most distressing were lack of energy and difficulty sleeping. Only 24 patients (16.4%) were treated for their difficulty sleeping with sleep medication. Importantly, those prescribed sleep medications had similar distress (3.9 ± 1.2 vs. 3.5 ± 1.2, p = 0.229) compared with patients not prescribed sleep medications. Opioids were prescribed to 57 (39.0%) patients; antidepressants to 34 (23.3%). Forty patients (27.4%) who reported moderate or greater depression were not prescribed an antidepressant. CONCLUSIONS The study highlights the multiple symptoms and distress experienced by patients with decompensated cirrhosis, and the need for improved medical management by health-care providers through enhanced awareness and attention to these complex symptoms. Future research should focus on improvements in symptom management.
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Kim S, Lee K, Kim C, Choi J, Kim S. How Do We Start Palliative Care for Patients With End-Stage Liver Disease? Gastroenterol Nurs 2022; 45:101-112. [PMID: 34269708 PMCID: PMC8963522 DOI: 10.1097/sga.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
Patients with end-stage liver disease undergo repetitive patterns of recovery and deterioration and are burdened with uncertainty. Although quality of life is low in patients with end-stage liver disease and their family members, few studies have been conducted to identify what palliative care should be provided for them. This integrative review aimed to explore palliative care for patients with end-stage liver disease, focusing on the components and outcome measurements for further research. After searching for studies on palliative care for end-stage liver disease published between 1995 and 2017, 12 studies that met the inclusion criteria were analyzed. The common components of palliative care for patients with liver disease were: (a) an interdisciplinary approach, (b) early palliative care, (c) discussion goals of care with patient and family members, (d) symptom management, and (e) psychosocial support. It was reported that patients who were provided palliative care had improved itching, well-being, appetite, anxiety, fatigue, and depression, increased the number of do-not-resuscitate orders, palliative care consultations, and decreased length of stay. These findings could guide the development of palliative care for end-stage liver disease patients.
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Affiliation(s)
- Sookyung Kim
- Correspondence to: Sanghee Kim, PhD, RN, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea ()
| | - Kyunghwa Lee
- Sookyung Kim, PhD, RN, is Postdoctoral Researcher, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
- Kyunghwa Lee, PhD, RN, is Assistant Professor, College of Nursing, Konyang University, Daejeon, Republic of Korea
- Changhwan Kim, MSN, RN, is Staff Nurse, Department of Critical Care Nursing, Samsung Medical Center, Seoul, Republic of Korea
- Jahyun Choi, MSN, RN, is Doctoral Student, Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
- Sanghee Kim, PhD, RN, is Associate Professor, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Changhwan Kim
- Sookyung Kim, PhD, RN, is Postdoctoral Researcher, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
- Kyunghwa Lee, PhD, RN, is Assistant Professor, College of Nursing, Konyang University, Daejeon, Republic of Korea
- Changhwan Kim, MSN, RN, is Staff Nurse, Department of Critical Care Nursing, Samsung Medical Center, Seoul, Republic of Korea
- Jahyun Choi, MSN, RN, is Doctoral Student, Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
- Sanghee Kim, PhD, RN, is Associate Professor, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Jahyun Choi
- Sookyung Kim, PhD, RN, is Postdoctoral Researcher, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
- Kyunghwa Lee, PhD, RN, is Assistant Professor, College of Nursing, Konyang University, Daejeon, Republic of Korea
- Changhwan Kim, MSN, RN, is Staff Nurse, Department of Critical Care Nursing, Samsung Medical Center, Seoul, Republic of Korea
- Jahyun Choi, MSN, RN, is Doctoral Student, Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
- Sanghee Kim, PhD, RN, is Associate Professor, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Sanghee Kim
- Sookyung Kim, PhD, RN, is Postdoctoral Researcher, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
- Kyunghwa Lee, PhD, RN, is Assistant Professor, College of Nursing, Konyang University, Daejeon, Republic of Korea
- Changhwan Kim, MSN, RN, is Staff Nurse, Department of Critical Care Nursing, Samsung Medical Center, Seoul, Republic of Korea
- Jahyun Choi, MSN, RN, is Doctoral Student, Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
- Sanghee Kim, PhD, RN, is Associate Professor, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
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Diaz-Aragon R, Coard MC, Amirneni S, Faccioli L, Haep N, Malizio MR, Motomura T, Kocas-Kilicarslan ZN, Ostrowska A, Florentino RM, Frau C. Therapeutic Potential of HNF4α in End-stage Liver Disease. Organogenesis 2021; 17:126-135. [PMID: 35114889 DOI: 10.1080/15476278.2021.1994273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The prevalence of end-stage liver disease (ESLD) in the US is increasing at an alarming rate. It can be caused by several factors; however, one of the most common routes begins with nonalcoholic fatty liver disease (NAFLD). ESLD is diagnosed by the presence of irreversible damage to the liver. Currently, the only definitive treatment for ESLD is orthotopic liver transplantation (OLT). Nevertheless, OLT is limited due to a shortage of donor livers. Several promising alternative treatment options are under investigation. Researchers have focused on the effect of liver-enriched transcription factors (LETFs) on disease progression. Specifically, hepatocyte nuclear factor 4-alpha (HNF4α) has been reported to reset the liver transcription network and possibly play a role in the regression of fibrosis and cirrhosis. In this review, we describe the function of HNF4α, along with its regulation at various levels. In addition, we summarize the role of HNF4α in ESLD and its potential as a therapeutic target in the treatment of ESLD.
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Affiliation(s)
- Ricardo Diaz-Aragon
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael C Coard
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sriram Amirneni
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lanuza Faccioli
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nils Haep
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michelle R Malizio
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Takashi Motomura
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Alina Ostrowska
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rodrigo M Florentino
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Carla Frau
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Patel AA, Woodrell C, Ufere NN, Hansen L, Tandon P, Verma M, Lai J, Pinotti R, Rakoski M. Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach. Hepatol Commun 2021; 5:1469-1480. [PMID: 34510839 PMCID: PMC8435283 DOI: 10.1002/hep4.1743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/28/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023] Open
Abstract
Individuals with advanced liver disease (AdvLD), such as decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC), have significant palliative needs. However, little research is available to guide health care providers on how to improve key domains related to palliative care (PC). We sought to identify priority areas for future research in PC by performing a comprehensive literature review and conducting iterative expert panel discussions. We conducted a literature review using search terms related to AdvLD and key PC domains. Individual reviews of these domains were performed, followed by iterative discussions by a panel consisting of experts from multiple disciplines, including hepatology, specialty PC, and nursing. Based on these discussions, priority areas for research were identified. We identified critical gaps in the available research related to PC and AdvLD. We developed and shared five key priority questions incorporating domains related to PC. Conclusion: Future research endeavors focused on improving PC in AdvLD should consider addressing the five key priorities areas identified from literature reviews and expert panel discussions.
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Affiliation(s)
- Arpan A. Patel
- Vatche and Tamar Manoukian Division of Digestive DiseasesDepartment of MedicineDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCAUSA
- Veterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA
| | - Christopher Woodrell
- Brookdale Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- James J. Peters Veterans Affairs Medical CenterBronxNYUSA
| | - Nneka N. Ufere
- Gastrointestinal UnitDepartment of MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Lissi Hansen
- School of NursingOregon Health Sciences UniversityPortlandORUSA
| | - Puneeta Tandon
- Department of MedicineCirrhosis Care ClinicEdmontonALCanada
- Liver Transplant UnitUniversity of AlbertaEdmontonALCanada
| | - Manisha Verma
- Department of Digestive Diseases and TransplantationEinstein Healthcare NetworkPhiladelphiaPAUSA
| | - Jennifer Lai
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Rachel Pinotti
- Gustave L. and Janet W. Levy LibraryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Mina Rakoski
- Division of Gastroenterology and HepatologyLoma Linda University HealthLoma LindaCAUSA
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Hansen L, Chang MF, Lee CS, Hiatt S, Firsick EJ, Dieckmann NF, Lyons KS. Physical and Mental Quality of Life in Patients With End-Stage Liver Disease and Their Informal Caregivers. Clin Gastroenterol Hepatol 2021; 19:155-161.e1. [PMID: 32289544 PMCID: PMC7554075 DOI: 10.1016/j.cgh.2020.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/20/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Management of end-stage liver disease (ESLD) has implications for not only patients' quality of life (QOL), but also their caregivers'. We aimed to identify characteristics of patients with ESLD and their caregivers that are associated with QOL. METHODS We obtained cross-sectional baseline data from patients and their caregivers (132 dyads; 62% were married or partners), recruited from outpatient hepatology clinics within 2 healthcare centers. Patients were included if their model for end-stage liver disease score was 15 or more; caregivers were identified by the patient as the primary informal caregiver. QOL was measured by the SF-36 and relationship quality using the mutuality scale. We measured uncertainty using the uncertainty in illness scales for patients and caregivers. Multilevel modeling was used to analyze the data. RESULTS Refractory ascites was associated with worse physical QOL for patients (unstandardized beta [B], -9.19; standard error [SE], 2.28) and caregivers (B, -5.41; SE, 2.33); history of hepatic encephalopathy was associated with worse patient physical QOL (B, -3.86; SE, 1.65). High levels of uncertainty were associated with worse physical and mental QOL for both members of the dyads; relationship quality was significantly associated with patient mental QOL (B, 2.73; SE, 1.19). CONCLUSIONS Clinicians and researchers should consider the effects of ESLD on caregivers as well as their patients to optimize the QOL for both.
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Affiliation(s)
- Lissi Hansen
- School of Nursing, Oregon Health & Science University, Portland, Oregon.
| | - Michael F Chang
- Gastroenterology & Hepatology, VA Portland Health Care System, Portland OR 97239, USA
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Boston MA 02467, USA
| | - Shirin Hiatt
- School of Nursing, Oregon Health & Science University, Portland OR 97239, USA
| | - Evan J Firsick
- School of Nursing, Oregon Health & Science University, Portland OR 97239, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, Portland OR 97239, USA
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Boston MA 02467, USA
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Yanny B, Pham NV, Saleh H, Saab S. Approaches to Assessing Burden in Caregivers of Patients with Cirrhosis. J Clin Transl Hepatol 2020; 8:127-134. [PMID: 32832392 PMCID: PMC7438349 DOI: 10.14218/jcth.2019.00054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/12/2020] [Accepted: 03/15/2020] [Indexed: 12/28/2022] Open
Abstract
Background and Aims: Being a caregiver for a patient with chronic liver disease (CLD) can be burdensome mentally, emotionally financially, and physically. The aim of this study was to systemically review the available tools and propose tools that can comprehensively evaluate caregiver burden for individuals caring for patients with CLD. Methods: We searched the PubMed database for all studies on the impact of patients with CLD on caregiver burden without timeframe restriction. Eligible studies included cohort studies, review studies, or cross-sectional studies. The number of patients and caregivers was isolated from each paper. Studies in the same categories were isolated and statistically compared. Results: A total of 13 studies meeting our inclusion criteria as stated in the methods sections were included. In total, 2528 caregivers were taking care of 2003 patients with CLD. Women made up the majority of caregivers at 78.2%, 95.7% of whom identified as the patient's spouse. Caregiver strain index is one of the most comprehensive tools; however, the questions are very general and do not fully elucidate financial strain. Beck depression and anxiety were correlated (p=0.0001), and both depression and anxiety were correlated with perceived caregiver burden (PCB) and Zarit Burden Interview (ZBI) (p=0.002). Depression scale correlated with Interpersonal Support Evaluation - Short Form, and Model for End-Stage Liver Disease score correlated with ZBI and PCB (total and in most domains; p=0.001). Patient's poorer cognitive performance correlated with higher ZBI and PCB (employed patients had higher cognitive performance and lower ZBI and PCB). Conclusions: Caregiver burden remains poorly understood due to the lack of uniformity in the assessment tools used to evaluate caregiver burden. None of the tools used to evaluate caregiver burden are comprehensive; however, most tools correlate statistically in the ability to identify caregiver burden. A comprehensive tool is lacking for identifying caregiver burden in patients with CLD.
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Affiliation(s)
- Beshoy Yanny
- Department of Medicine, University of California at Los Angeles, CA, USA
| | - Nguyen V. Pham
- Department of Surgery, University of California at Los Angeles, CA, USA
| | - Hussein Saleh
- Department of Surgery, University of California at Los Angeles, CA, USA
| | - Sammy Saab
- Department of Medicine, University of California at Los Angeles, CA, USA
- Department of Surgery, University of California at Los Angeles, CA, USA
- Correspondence to: Sammy Saab, Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA. Tel: +1-310-206-6705, Fax: +1-310-206-4197, E-mail:
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Verma M, Tapper EB, Singal AG, Navarro V. Nonhospice Palliative Care Within the Treatment of End-Stage Liver Disease. Hepatology 2020; 71:2149-2159. [PMID: 32167615 PMCID: PMC10362480 DOI: 10.1002/hep.31226] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/19/2020] [Indexed: 01/03/2023]
Abstract
Palliative care (PC) that has evolved from a focus on end-of-life care to an expanded form of holistic care at an early stage for patients with serious illnesses and their families is commonly referred to as nonhospice PC (or early PC). Patients with end-stage liver disease (ESLD) suffer from a high symptom burden and a deteriorated quality of life (QOL), with uncertain prognosis and limited treatment options. Caregivers of these patients also bear an emotional and physical burden similar to that of caregivers for patients with cancer. Despite the proven benefits of nonhospice PC for other serious illnesses and cancer, there are no evidence-based structures and processes to support its integration within the routine care of patients with ESLD and their caregivers. In this article, we review the current state of PC for ESLD and propose key structures and processes to integrate nonhospice PC within routine hepatology practice. Results found that PC is highly underutilized within ESLD care, and limited prospective studies are available to demonstrate methods to integrate PC within routine hepatology practices. Hepatology providers report lack of training to deliver PC along with no clear prognostic criteria on when to initiate PC. A well-informed model with key structures and processes for nonhospice PC integration would allow hepatology providers to improve clinical outcomes and QOL for patients with ESLD and reduce health care costs. Educating hepatology providers about PC principles and developing clear prognostic criteria for when and how to integrate PC on the basis of individual patient needs are the initial steps to inform the integration. The fields of nonhospice PC and hepatology have ample opportunities to partner clinically and academically.
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Affiliation(s)
- Manisha Verma
- Department of Digestive Diseases and Transplantation, Einstein Healthcare Network, Philadelphia, PA
| | - Elliot B Tapper
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI
| | - Amit G Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX
| | - Victor Navarro
- Department of Digestive Diseases and Transplantation, Einstein Healthcare Network, Philadelphia, PA
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11
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Zhu R, Wang Y, Wu R, Meng X, Han S, Duan Z. Trends in high-impact papers in nursing research published from 2008 to 2018: A web of science-based bibliometric analysis. J Nurs Manag 2020; 28:1041-1052. [PMID: 32458514 DOI: 10.1111/jonm.13038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess the overall trends in the development and citation impact of high-impact papers in nursing research worldwide to gain insight into the focus areas of nursing research. BACKGROUND Bibliometric method is proved to be effective in analysing the papers' characteristics, and it gained considerable interest from the scientific community in recent years. An analysis of the characteristics and intrinsic patterns of high-impact papers in nursing research will provide an objective reflection of the research hot spots. Nursing managers can pointedly increase funding amount and strengthen research cooperation in order to put the scientific results into management practice. METHODS Bibliometric methods and visualization software were used to comprehensively analyse high-impact papers in nursing research in terms of development trends, countries/regions, distribution of subject areas, research institutes, collaborative networks and subject terms. RESULTS There were 6,886 papers between 2008 and 2018. The number of papers increased from 528 in 2008 to 723 in 2015, and then remained above 600 in 2016 and 2017. These papers were mainly distributed in nursing, oncology, paediatrics, gynaecology, teaching and education, and cardiac and cardiovascular systems and were cited by 128,845 papers that came from 89 Web of Science subject areas. Papers in nursing research accounted for the largest share of these citations. The top five countries in the world in terms of the number of high-impact papers were the United States, Australia, the United Kingdom, Canada and Sweden. The research institutions with the highest number of high-impact papers worldwide were the University of California System, the University of Pennsylvania, the University of North Carolina, the University of London and the University of Technology Sydney. In this data set, it was shown that research collaborative circles have been formed in the United States, Australia, Canada and Europe; the subject-term analysis indicated that 'women' and 'students' have always been high-interest populations for high-impact papers and that cancer is still one of the greatest threats to human health. Furthermore, the subject terms of high-impact papers in nursing research have gradually evolved from 'disease' and 'therapy' to 'symptoms'. CONCLUSION In recent years, the number of high-impact papers published each year in nursing research has grown over time. Nursing has been shown to be a highly specialized subject, and the majority of its high-impact papers have been published by research institutions. Although cross-regional collaborations are beginning to emerge, there is much room for improvement in this regard. Finally, women, students, cancer and symptomatic care are the current focus areas in nursing research. IMPLICATIONS FOR NURSING MANAGEMENT This study informs nursing managers within the nursing research field about subject areas, collaborative networks and hot topics. It is beneficial to pay attention to studies, manage scientific outputs, allocate resources, seek cooperation and improve the work efficiency of scientific research management.
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Affiliation(s)
- Ruifang Zhu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Yaping Wang
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Rui Wu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Xin Meng
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Shifan Han
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Zhiguang Duan
- School of Nursing, Shanxi Medical University, Taiyuan, China
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Lee CS, Faulkner KM, Thompson JH. Identifying subgroups: Part 2: Trajectories of change over time. Eur J Cardiovasc Nurs 2020; 19:444-450. [PMID: 32131616 DOI: 10.1177/1474515120911330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Methods to identify multiple trajectories of change over time are of great interest in nursing and in related health research. Latent growth mixture modeling is a data-centered analytic strategy that allows us to study questions about distinct trajectories of change in key measures or outcomes of interest. In this article, a worked example of latent growth mixture modeling is presented to help expose researchers to the use and appeal of this analytic strategy.
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Lee CS, Faulkner KM, Thompson JH. Identifying subgroups: Part 1: Patterns among cross-sectional data. Eur J Cardiovasc Nurs 2020; 19:359-365. [PMID: 32126820 DOI: 10.1177/1474515120911323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Non-experimental designs are common in nursing and allied health research wherein study participants often represent more than a single population or interest. Hence, methods used to identify subgroups and explore heterogeneity have become popular. Latent class mixture modeling is a versatile and person-centered analytic strategy that allows us to study questions about subgroups within samples. In this article, a worked example of latent class mixture modeling is presented to help expose researchers to the nuances of this analytic strategy.
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14
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Cipolletta S, Entilli L, Nucci M, Feltrin A, Germani G, Cillo U, Volpe B. Psychosocial Support in Liver Transplantation: A Dyadic Study With Patients and Their Family Caregivers. Front Psychol 2019; 10:2304. [PMID: 31649602 PMCID: PMC6795706 DOI: 10.3389/fpsyg.2019.02304] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/27/2019] [Indexed: 12/17/2022] Open
Abstract
Background and aims: Liver transplantation provides an opportunity of survival for patients with liver failure; however, this procedure is known to be psychologically and physically fatiguing for patients and their informal caregivers. The aim of this study was to investigate how perceived social support and the distribution of dependency were associated with the psychological wellbeing of patients waiting for liver transplantation and their caregivers, as a dyad. Methods: The present was a cross-sectional study. Ninety-five participants were recruited at a hospital in Northern Italy, during the psychological evaluation for inclusion in the transplantation list: 51 patients (19 with alcohol-related illness) and 44 family caregivers. Both patients and caregivers filled in a Symptom Checklist and Kelly’s Dependency Grids. Patients also compiled the Medical Outcome Study Social-Support Survey, and caregivers compiled the Family Strain Questionnaire Short-Form. Results: Caregivers reported important levels of strain and strongly related to a worsening of their own and patients’ symptoms. Patients with alcohol-related pathologies had a narrower social network, which corresponded to an increase in family strain. On the sample as a whole, regression analyses showed that perceived social support and dependency measures did not predict patients’ and caregivers’ symptoms. Nevertheless, cluster analysis identified a group of caregivers who distributed their dependency more and experienced lower levels of depression, anxiety, and strain. Conclusions: These results suggest the usefulness of a dyadic approach in the research, prevention, and care of liver diseases. A deeper comprehension of the functioning of dyads will help practitioners in the identification of situations at risk.
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Affiliation(s)
| | - Lorenza Entilli
- Department of General Psychology, University of Padua, Padua, Italy
| | - Massimo Nucci
- Department of General Psychology, University of Padua, Padua, Italy
| | | | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Department of General Surgery and Organ Transplantation, Padua University Hospital, Padua, Italy
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Fricker ZP, Serper M. Current Knowledge, Barriers to Implementation, and Future Directions in Palliative Care for End-Stage Liver Disease. Liver Transpl 2019; 25:787-796. [PMID: 30758901 DOI: 10.1002/lt.25434] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/10/2019] [Indexed: 02/07/2023]
Abstract
End-stage liver disease (ESLD) is associated with a high degree of morbidity and mortality as well as symptom burden. Despite this, the rate of consultation with palliative care (PC) providers remains low, and invasive procedures near the end of life are commonplace. Studies show that involvement of PC providers improves patient satisfaction, and evidence from other chronic diseases demonstrates reduced costs of care and potentially increased survival. Better integration of PC is imperative but hindered by patient and provider misconceptions about its role in the care of patients with ESLD, specifically among candidates for liver transplantation. Additionally, reimbursement barriers and lack of provider knowledge may contribute to PC underutilization. In this review, we discuss the benefits of PC in ESLD, the variability of its delivery, and key stakeholders' perceptions about its use. Additionally, we identify barriers to more widespread PC adoption and highlight areas for future research.
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Affiliation(s)
- Zachary P Fricker
- Division of Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Marina Serper
- Division of Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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