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Hospice and Palliative Care in End Stage Liver Disease

말기 간질환 환자에서의 호스피스 완화의료

  • Kim, Moon Young (Department of Internal Medicine, Yonsei University Wonju College of Medicine)
  • 김문영 (연세대학교 원주의과대학 내과학교실)
  • Received : 2017.08.07
  • Accepted : 2017.08.08
  • Published : 2017.09.01

Abstract

End-stage liver disease (ESLD) is a terminal condition of cirrhosis which cannot be treated without liver transplantation. Thus, it is natural for patients to consider hospice/palliative care (HPC). Since the recent legislation of the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life (Act No. 14013) in Korea, the practicality of this law has become an issue. The criteria for HPC should be defined with consideration to how the severity of each ESLD complication may vary by individual patients. Generally, patients qualify if they have an intractable condition despite aggressive treatment such as the hepatorenal syndrome, hepatic encephalopathy or variceal hemorrhage. However, the option of liver transplantation should be sufficiently discussed with patients and their families before making a decision on HPC. The evaluation of which ESLD patients should receive HPC should be based on a long-term doctor-patient relationship and sufficient objective data. Therefore, a multidisciplinary approach and mutual consultation among cirrhosis specialists and doctors with other expertise are essential to offer optimal and balanced treatments between liver-specific treatment and HPC. Discussed in this review are adequate criteria for HPC and special considerations for ESLD at the point of HPC.

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