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Abstract Details
The Patient's Perspective in Cirrhosis: Unmet Supportive Care Needs Differ by Disease Severity, Etiology, and Age
Hepatol Commun. 2021 Feb 6;5(5):891-905. doi: 10.1002/hep4.1681. eCollection 2021 May.
Patricia C Valery1, Christina M Bernardes1, Benjamin Mckillen23, Samath Amarasena4, Katherine A Stuart2, Gunter Hartel1, Paul J Clark25, Richard Skoien4, Tony Rahman6, Leigh Horsfall23, Kelly Hayward23, Rohit Gupta6, Andrew Lee5, Leshni Pillay7, Elizabeth E Powell23
Author information
1QIMR Berghofer Medical Research Institute Herston QLD Australia.
2Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane QLD Australia.
3Centre for Liver Disease Research Translational Research Institute Faculty of Medicine University of Queensland Brisbane QLD Australia.
4Department of Gastroenterology and Hepatology Royal Brisbane and Women's Hospital Brisbane QLD Australia.
5Department of Gastroenterology and Hepatology Mater Hospitals Brisbane QLD Australia.
6Gastroenterology & Hepatology Department Prince Charles Hospital Chermside QLD Australia.
7Department of Gastroenterology and Hepatology Logan Hospital Meadowbrook QLD Australia.
Abstract
Patients with cirrhosis have significant physical, psychological, and practical needs. We documented patients' perceived need for support with these issues and the differences with increasing liver disease severity, etiology, and age. Using the supportive needs assessment tool for cirrhosis (SNAC), we examined the rate of moderate-to-high unmet needs (Poisson regression; incidence rate ratio [IRR]) and the correlation between needs and sociodemographic/clinical characteristics (multivariable linear regression) in 458 Australians adults with cirrhosis. Primary liver disease etiology was alcohol in 37.6% of patients, chronic viral hepatitis C in 25.5%, and nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) in 23.8%. A total of 64.6% of patients had Child-Pugh class A cirrhosis. Most patients (81.2%) had at least one moderate-to-high unmet need item; more than 25% reported a moderate-to-high need for help with "lack of energy," "sleep poorly," "feel unwell," "worry about … illness getting worse (liver cancer)," "have anxiety/stress," and "difficulty with daily tasks." Adjusting for key sociodemographic/clinical factors, patients with Child-Pugh C had a greater rate of "practical and physical needs" (vs. Child-Pugh A; IRR = 2.94, 95% confidence interval [CI] 2.57-3.37), patients with NAFLD/NASH had a greater rate of needs with "lifestyle changes" (vs. alcohol; IRR = 1.81, 95% CI 1.18-2.77) and "practical and physical needs" (IRR = 1.43, 95% CI 1.23-1.65), and patients aged ≥65 years had fewer needs overall (vs. 18-64 years; IRR = 0.70, 95% CI 0.64-0.76). Higher overall SNAC scores were associated with Child-Pugh B and C (both P < 0.001), NAFLD/NASH (P = 0.028), patients with "no partner, do not live alone" (P = 0.004), unemployment (P = 0.039), ascites (P = 0.022), and dyslipidemia (P = 0.024) compared with their counterparts. Conclusion: Very high levels of needs were reported by patients with cirrhosis. This information is important to tailor patient-centered care and facilitate timely interventions or referral to support services.