Improvement in Quality of Life and Activities of Daily Living in Patients with Liver Cirrhosis with the Use of Health Education and Patient Health Empowerment

Impact of liver transplantation on the quality of life of a cohort of high-risk recipients

BACKGROUND

Liver transplantation significantly improves the health-related quality of life of patients with cirrhosis and high MELD scores. This study highlights rapid health-related quality of life gains after transplantation that were sustained during the one-year follow-up period, emphasizing the role of multidisciplinary care in achieving these outcomes.

OBJECTIVE

To assess the effects of liver transplantation on the health-related quality of life of patients with cirrhosis on the waiting list for transplantation.

METHODS

This retrospective study analyzed HRQOL using the EQ-5D questionnaire before (T0), and 3 (T3), 6 (T6), and 12 (T12) months after, transplantation. The questionnaire comprised five health status scores, which were also combined into a single utility score. Changes in each dimension and in the utility score were examined.

RESULTS

A total of 212 patients were included in the study, with a mean age of 54 (SD, 12) years, and a median Model for End-Stage Liver Disease score of 17 (Q1= 11; Q3= 24). The most frequent etiology was chronic alcoholism (26.9%). Improvements in EQ-5D utility scores were registered at all post-transplantation time points compared to the score at T0: an increase of 0.22 points (p<0.001) at T3, 0.27 (p<0.001) at T6, and 0.268 (p<0.001) at T12. Scores increased over time in all domains of the EQ-5D.

CONCLUSION

In a large sample of high-risk transplant recipients, a significant improvement in HRQOL occurred three months after transplantation, and was sustained over the one-year follow-up period.

BACKGROUND

■ Liver transplantation improves health-related quality of life in patients with cirrhosis and high MELD scores.

BACKGROUND

■ Significant health-related quality of life improvements occur within three months of transplantation.

BACKGROUND

■ Multidisciplinary care programs enhance post-iver transplantation physical and mental recovery.

BACKGROUND

■ Sustained health-related quality of life gains highlight the long-term benefits of liver transplantation.

Self-management interventions to patients with cirrhosis: A scoping review

BACKGROUND

Self-management in chronic diseases like cirrhosis involves patients providing the necessary knowledge, skills, and confidence to enhance self-efficacy. This scoping review aims to describe the literature on self-management interventions in patients with cirrhosis to create an overview and identify key concepts and gaps in the existing literature.

METHODS

Four databases (CINAHL, Embase, Medline, and Scopus) were searched from November 2022 to September 2024. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Studies published from 2000 onward, including patients with cirrhosis of different etiology and severity, focusing on self-management and/or self-efficacy, and performed in a health care setting, were considered.

RESULTS

The search produced 1012 articles, of which 16 were included in the review. These represented studies from 7 countries and a sample of 1.276 patients. The studies differed in study design, sample size, delivery format, self-management interventions designed by the authors, and evaluation. However, all studies described some form of improvement in patient-related and clinical outcomes after the intervention, mainly improved patient knowledge and quality of life.

CONCLUSIONS

Self-management interventions for patients with cirrhosis improved patient-related outcomes. However, more comprehensive and standardized interventions tailored to patients' needs are needed. These self-management interventions should focus on increasing confidence and self-efficacy and address the different skills required by patients to manage their disease.

Knowledge needs in patients with Liver Disease: a qualitative study

BACKGROUND

Knowledge is essential for patients' disease management strategies and a critical component of healthcare. The importance of increasing patients level of knowledge has become more widely acknowledge in liver disease management in recent years, but further studies are needed to address patients experiences of unmet knowledge needs to develop appropriate patient education strategies. Therefore, the aim of this study was to explore knowledge needs in patients' with liver disease of different etiology and severity.

METHODS

A qualitative study was designed and an inductive method was chosen. Thirty-three patients with liver disease of different etiology and severity were interviewed using a semi-structured interview guide. Content analysis was used as an inspiration to describe and compare patients' needs for knowledge across disease etiology and severity. The reporting followed consolidated criteria for reporting qualitative research.

RESULTS

The analysis generated three categories and nine subcategories. In general, the patients described lack of knowledge related to their liver disease, which made it difficult for them to manage their disease. Patients wished to be more involved in care and treatment of the liver disease. However, patients' had difficulties to assess and understand the importance of the information they received from healthcare professionals. Due to lack of knowledge, patients' had a misconception of the liver disease. Patients' had variation in knowledge needs depending on liver disease etiology and severity.

CONCLUSION

Within liver disease management, knowledge of patients' experiences is vital to meet patients' knowledge needs and to develop appropriate patient education strategies. Therefore, it is important to ascertain a patient-centered approach to accommodate patients' individual knowledge needs, involve patients in care and treatment, and insure understanding to strengthen their self-management and give the patients the necessary skills to manage their disease and everyday life.

REGISTRATION NUMBER

Open Science Framework registration DOI https://doi.org/10.17605/OSF.IO/W28RC .

Comparison of the quality of life of patients with liver cirrhosis before and during the COVID-19 lockdown in Slovakia

Liver cirrhosis is associated with a poor quality of life (QOL). The COVID-19 pandemic has led to several restriction measures and psychosocial consequences whose impact on QOL has combined with that of cirrhosis in an unknown way. Therefore, we have used our cirrhosis registry to assess the quality of life before the pandemic (on the first admission to the tertiary liver unit) and during the most pronounced phase of the first lockdown. In this cross-sectional study conducted during the first lockdown in Slovakia (from April to May 2020), we have repeated the QOL measurement of QOL in cirrhotic patients previously enrolled in the RH7 registry. Patients who were alive (according to the national registry of deaths) were identified and contacted by phone with a structured and standardized interview led by trained professionals. The tool used for both QOL measurements (at enrolment in RH7 and during lockdown) was a standardized and validated EuroQOL-5D (EQ-5D) questionnaire. The study included 97 patients, of which 37 (38.1%) were women and 60 (61.9%) were men. Responses were achieved from 75 patients (68.18%). In general, patients scored their quality of life significantly higher during the pandemic compared to examination at admission to RH7 (that is, at admission to our tertiary liver unit with cirrhosis) (p = 0.005). In particular, of the domains included in EQ-5D: (1) self-care was better during lockdown compared to the first record on admission to RH7 (p < 0.001). (2) the ability to perform daily activities has also improved during lockdown (p = 0.002). On the other hand, (3) pain and discomfort did not change significantly during the lockdown compared to the previous measurement (p = 0.882). (4) anxiety and depression were lower during lockdown compared to admission to RH7 (p = 0.01). The quality of life in patients with liver cirrhosis was better during the lockdown of SARS-CoV-2 compared to the previous measurement at admission to the tertiary liver unit.

Nurse-assisted and multidisciplinary outpatient follow-up among patients with decompensated liver cirrhosis: A systematic review

BACKGROUND AND OBJECTIVE

Liver cirrhosis represents a considerable health burden and causes 1.2 million deaths annually. Patients with decompensated liver cirrhosis have a poor prognosis and severely reduced health-related quality of life. Nurse-led outpatient care has proven safe and feasible for several chronic diseases and engaging nurses in the outpatient care of patients with liver cirrhosis has been recommended. At the decompensated stage, the treatment and nursing care are directed at specific complications, educational support, and guidance concerning preventive measures and signs of decompensation. This review aimed to assess the effects of nurse-assisted follow-up after admission with decompensation in patients with liver cirrhosis from all causes.

METHOD

A systematic search was conducted through February 2022. Studies were eligible for inclusion if i) they assessed adult patients diagnosed with liver cirrhosis that had been admitted with one or more complications to liver cirrhosis and ii) if nurse-assisted follow-up, including nurse-assisted multidisciplinary interventions, was described in the manuscript. Randomized clinical trials were prioritized, but controlled trials and prospective cohort studies with the intervention were also included. Primary outcomes were mortality and readmission, but secondary subjective outcomes were also assessed.

RESULTS AND CONCLUSION

We included eleven controlled studies and five prospective studies with a historical control group comprising 1224 participants. Overall, the studies were of moderate to low quality, and heterogeneity across studies was substantial. In a descriptive summary, the 16 studies were divided into three main types of interventions: educational interventions, case management, and standardized hospital follow-up. We saw a significant improvement across all types of studies on several parameters, but currently, no data support a specific type of nurse-assisted, post-discharge intervention. Controlled trials with a predefined intervention evaluating clinically- and practice-relevant endpoints in a real-life, patient-oriented setting are highly warranted.

Morbimortality Associated with Liver Cirrhosis in Peru: An Ecological Analysis for the Period of 2004-2016

Liver cirrhosis (LC) is an irreversible, chronic disease and constitutes the last clinical stage of many different liver diseases. The main cause of death is upper gastrointestinal bleeding caused by esophageal variceal rupture. We aim to depict the trend and estimate the morbimortality. For this, we conducted an ecological study and analyzed data from 2004-2016 using the public information provided by the Peruvian Ministry of Health (Ministerio de Salud del Perú, MINSA). Morbidity and mortality were presented according to 5-year groups. Regions were divided according to age quintiles for each studied year, and standardized morbidity and mortality rates were calculated for each natural geographic region; we found that LC-related morbidity per 100,000 people was 52.3 in 2004 and 117.9 in 2016. LC-related mortality had increased from 13.6 deaths per 100,000 people in 2004-2005 to 16.8 deaths per 100,000 people in 2015-2016. Morbidity showed an upward trend in Peru, especially in the departments of Callao, Ica, and Tumbes, whereas mortality showed an upward trend in the departments of Lambayeque, Ica, and Callao.

Differences in anxiety among patients with liver cirrhosis with different compensation abilities

OBJECTIVE

To explore the difference in anxiety and mental health of patients with liver cirrhosis with different compensatory abilities, so as to provide comprehensive treatment measures such as individualized psychological support for patients.

METHODS

In this retrospective study, a total of 175 patients with liver cirrhosis admitted to the Department of Infectious Diseases, Fifth Hospital of Sun Yat-sen University from January to December 2019 were included and divided into a compensated group (n=77) and a decompensated group (n=98). The anxiety of patients was evaluated on the day of admission, one week after hospitalization, and the day of discharge using the Self-Rating Anxiety Scale (SAS). Psychological investigations were conducted on the two groups of patients with cirrhosis.

RESULTS

The SAS score of patients in the decompensated group was higher than that of the compensated group on the day of admission (48.62±6.35 vs. 37.68±8.94, F=20.313), one week after hospitalization (56.95±7.47 vs. 42.79±10.77, F=29.879), and on the day of discharge (42.95±7.85 vs. 36.43±9.29, F=7.110) (P<0.05). The SAS score of male patients in the decompensated group was higher than that of the compensated group on the day of admission (47.50±6.25 vs. 36.70±9.92, t=-4.112), one week after hospitalization (57.25±5.80 vs. 42.10±13.24, t=-4.538) and on the day of discharge (42.33±7.34 vs. 36.19±9.65, t=-2.162) (all P<0.05). The SAS score of 40-59 year-old patients of the decompensated group was higher than that of patients in the compensated group of the same age on the day of admission (51.80±6.26 vs. 36.84±8.57, t=-4.372), one week after hospitalization (60.6±7.06 vs. 42.94±10.33, t=-4.382), and on the day of discharge (48.60±4.16 vs. 37.32±10.23, t=-3.768) (P<0.05). The SAS score of female patients in the decompensated group was higher than that in the compensated group at one week after hospitalization (56.56±9.65 vs. 35.45±18.66, t=-4.617) (P<0.05). There was no difference in the SAS score between patients of different groups on the day of admission and the day of discharge (P>0.05).

CONCLUSION

The anxiety of patients with different compensatory abilities of the liver is adversely affected by the severity of their illness and the length of hospitalization. The anxiety of male patients in the decompensated group is more significant than that of patients in the compensated group, while no significant difference was observed in anxiety between female patients in the decompensated group and those in the compensated group on the day of admission and discharge. It is necessary to strengthen psychological intervention, optimize the treatment methods, and reduce the average hospital stay in decompensated patients.

Poor disease knowledge is associated with higher healthcare service use and costs among patients with cirrhosis: an exploratory study

BACKGROUND

Optimal management of cirrhosis is complex, and patients often lack knowledge and skills, which can affect self-management. We assessed patient knowledge about cirrhosis and examined whether knowledge was associated with clinical outcomes, healthcare service use, and healthcare costs. A cross-sectional 'knowledge survey' was conducted during 2018-2020. We assessed patient knowledge about cirrhosis and explore whether knowledge was associated with clinical outcomes, healthcare service use, and costs.

METHODS

Patients with cirrhosis (n = 123) completed a 'knowledge survey'. We calculated the proportion of correct answers to eight questions deemed to be "key knowledge" about cirrhosis by an expert panel, and dichotomized patients as 'good knowledge'/'poor knowledge'. Clinical data, healthcare costs, and health-related quality of life (SF-36) were available.

RESULTS

58.5% of patients had 'good knowledge' about cirrhosis. Higher education level was associated with higher odds of having 'good knowledge' about cirrhosis (adjusted-OR = 5.55, 95%CI 2.40-12.84). Compared to patients with 'poor knowledge', those with 'good knowledge' had a higher health status in the SF-36 physical functioning domain (p = 0.011), fewer cirrhosis-related admissions (adjusted incidence rate ratio [IRR] = 0.59, 95%CI 0.35-0.99) and emergency presentations (adj-IRR = 0.34, 95%CI 0.16-0.72), and more planned 1-day cirrhosis admissions (adj-IRR = 3.96, 95%CI 1.46-10.74). The total cost of cirrhosis admissions was lower for patients with 'good knowledge' (adj-IRR = 0.30, 95%CI 0.29-0.30).

CONCLUSION

Poor disease knowledge is associated with increased use and total cost of healthcare services. Targeted educational interventions to improve patient knowledge may be an effective strategy to promote a more cost-effective use of healthcare services.

Partnering with support persons and clinicians to improve the health care experiences of patients with cirrhosis

AIM

To explore the care experiences of Aboriginal and Torres Strait Islander Australians diagnosed with cirrhosis with a focus on support needed.

BACKGROUND

Cirrhosis disproportionately affects Indigenous Australians, and liver diseases contribute to the mortality gap between Indigenous and other Australian adults.

DESIGN

A qualitative study.

METHODS

Using yarning methods, Indigenous patients (n = 13) and support persons (n = 3) were interviewed by an Aboriginal researcher during April-July, 2020. Thematic analysis was used to identify common themes using an inductive approach.

RESULTS

Six themes emerged. (1) Experience of diagnosis. This theme included stories of delays in the system, self-awareness of signs and symptoms and relief of being diagnosed. (2) 'Shame, shame, shame'. Experiences of prejudices and discrimination from health professionals, the lack of understanding of cirrhosis among health professionals, and stories about alcohol cessation and counselling around alcohol cessation. (3) Health literacy. Participants' understanding of cirrhosis was variable. While the importance of knowledge was recognised, 'what works for someone might not work for others'. Several patients partnered with their support persons and clinicians to bridge the health literacy gap. (4) Sources of support included family and friends, transport facilities, health professionals and peers. (5) Positive and negative aspects of communication and patient consultation were discussed. (6) Psychosocial counselling to 'look after the caring side'. The need for more mental health care services was raised.

CONCLUSION

Barriers related to poor health literacy, stigma and lack of practical and emotional support, and issues with communication and patient consultation, may lead to inequitable access to cirrhosis care and treatment for Indigenous Australians.

RELEVANCE TO CLINICAL PRACTICE

Gaining knowledge of the experiences of Indigenous Australians with cirrhosis is important for providing patient-centred and culturally appropriate care. Liver specialist nurses have an important role in bridging the health literacy gap and in supporting Indigenous patients and families.

Defining an enabling environment for those with chronic disease: an integrative review

BACKGROUND

Health policies are currently being implemented to cope with the 37% of those affected by chronic disease and 63% of deaths worldwide. Among the proposals, there is accelerating support for greater autonomy for patients, which incorporates several concepts, including empowerment. To achieve this, develop an environment to increase an individual's capacity for action seems to be a fundamental step. The aim of this study is to characterize an enabling environment for patients in the context of chronic disease management.

METHODS

An integrative review design was applied. Medline, CINAHL, and Web of Science databases were searched to identify relevant literature published between 2009 and 2019. Overall, the review process was guided by the PRISMA 2020 checklist. The Mixed Methods Appraisal Tool for quality evaluation was used.

RESULTS

A total of 40 articles were analyzed, divided into 18 quantitative studies, 11 qualitative studies, two mixed studies, seven expert opinions, one theory and one conference report. The following characteristics defining an enabling environment were taken from the literature relating to those with a chronic condition: Needs assessment-adaptation of responses, supporting "take care", involvement in support, knowledge improvement, engagement with professionals, use of information and communication technologies, and organization of care. Beyond that, the interactions highlighted between these seven categories characterize an enabling environment.

CONCLUSION

This review specifies the essential elements of an enabling environment for patients with chronic conditions. It encompasses the partnership between the healthcare professional, such as the advanced practice nurse, and the individual for whom interventions and care strategies must be devised.

Relationship between symptoms and both stage of change in adopting a healthy life style and quality of life in patients with liver cirrhosis: a cross-sectional study

BACKGROUND

Previous studies of patients with liver cirrhosis have not considered the broad range of symptoms or the association between healthy behavior and quality of life. The purposes of this study were to examine the association between symptoms and adopting exercise and consuming fruits and vegetables and to identify factors associated with quality of life in patients with liver cirrhosis.

METHODS

This cross-sectional study enrolled 91 consecutive patients with liver cirrhosis in one tertiary general hospital in South Korea between February 2016 and January 2017. Each study participant completed a self-administered questionnaire that measured symptom, stage of change in engaging in exercise and consumption of fruits and vegetables, and the Korean version of the 36-item Short-Form Health Survey. Multivariate ordinal logistic regression analysis and multiple regression models was used, respectively, to examine the association between each symptom with stage of change in engaging in exercise and consumption of fruits and vegetables and to evaluate factors affecting quality of life.

RESULTS

Experiencing nausea was associated with more readiness for change in engaging in exercise, but experiencing shortness of breath was associated with less readiness for change in engaging in exercise. Experiencing right upper quadrant pain was associated with more readiness for change in engaging in consumption of fruits and vegetables. Muscle cramps, anorexia, right upper quadrant pain and body pain, itching, ascites or edema, bruising, and change in appearance negatively affected quality of life.

CONCLUSIONS

The results suggest that the types of symptoms experienced by a patient with liver cirrhosis hinder or promote the patient's adoption of exercise and dietary behavior. Experiencing symptoms may negatively affect quality of life. Caregivers should provide supportive care to patients with liver cirrhosis, which includes assessing and managing symptoms to improve quality of life.

How Do Patients With Cirrhosis and Their Caregivers Learn About and Manage Their Health? A Review and Qualitative Study

The complexity of cirrhosis requires patients and their caregivers to be well educated to improve outcomes. Data are lacking regarding how to best educate patients and their caregivers in the setting of cirrhosis. Our aim is to understand (both through existing literature and by asking patients and their caregivers) how patients learn about their disease, barriers in their education and disease management, and self-management strategies. We performed a structured search of published articles in PubMed (1973 to 2020) using keywords "cirrhosis" plus "barriers", "education", "self-management", or "self-care". Additionally, we conducted a focus group of a representative sample of patients and their caregivers to understand how knowledge about cirrhosis is found and incorporated into self-management. Of 504 returned manuscripts, 11 pertained to barriers in cirrhosis, interventions, or educational management. Barriers are well documented and include disease complexity, medication challenges, comorbid conditions, and lack of effective education. However, data regarding addressing these barriers, especially effective educational interventions, are scarce. Current strategies include booklets and videos, patient empowerment, and in-person lectures. Without widespread use of these interventions, patients are left with suboptimal knowledge about their disease, a sentiment unanimously echoed by our focus group. Despite linkage to subspecialty care and consistent follow-up, patients remain uncertain about their disease origin, prognosis, and therapies to manage symptoms. It is clear that more data are needed to assess effective strategies to address unmet educational needs. Existing strategies need to be blended and improved, their effectiveness evaluated, and the results distributed widely.