title: Benefit of Early Palliative Care Intervention in End-Stage Liver Disease Patients Awaiting Liver Transplantation.
abstract: BACKGROUND
  Patients with end-stage liver disease have a predictable and progressive decline in their quality of life because of physical symptoms and psychological distress. Early palliative care intervention (EPCI) correlates with better symptom control and mood. We aimed to improve symptomatology and mood in liver transplant candidates by implementing a longitudinal multidisciplinary EPCI.
  
  
  METHODS
  Depression level and symptom burden were assessed with Center for Epidemiological Studies Depression Scale and a modified liver-specific Edmonton Symptom Assessment System scale.
  
  
  METHODS
  All patients referred for liver transplant evaluation between July 2013 and May 2014 were scheduled for EPCI.
  
  
  RESULTS
  After EPCI, 50% of moderate-to-severe symptoms improved (P < 0.05), and 43% of patients showed improvement in clinically significant depressive symptoms (P = 0.003). Notably, patients with more symptoms showed a greater improvement in Center for Epidemiological Studies Depression Scale scores (P = 0.001).
  
  
  CONCLUSIONS
  Implementation of EPCI improved symptom burden and mood in end-stage liver disease patients awaiting transplant.
authors: Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors: Alexandra J
authors: AJ
authors: Baumann
authors: Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors: David S
authors: DS
authors: Wheeler
authors: Division of Hepatology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors: Marva
authors: M
authors: James
authors: Division of Palliative Care, Duke University Medical Center, Durham, North Carolina, USA.
authors: Roberta
authors: R
authors: Turner
authors: Division of Palliative Care, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors: Arthur
authors: A
authors: Siegel
authors: Division of Hepatology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA. Electronic address: navarrov@einstein.edu.
authors: Victor J
authors: VJ
authors: Navarro
mesh_terms: D000339:Affect; D017281:Cost of Illness; D003863:Depression; D058625:End Stage Liver Disease / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: CES-D; ESAS; End-stage liver disease; cirrhosis; early palliative care intervention; liver transplant