Palliative clinical trials in advanced chronic liver disease: Challenges and opportunities

Abstract

Patients with advanced chronic liver disease have a complex symptom burden and many are not candidates for curative therapy. Despite this, provision of palliative interventions remains woefully inadequate, with an insufficient evidence base being a contributory factor. Designing and conducting palliative interventional trials in advanced chronic liver disease remains challenging for a multitude of reasons. In this manuscript we review past and ongoing palliative interventional trials. We identify barriers and facilitators and offer guidance on addressing these challenges. We hope that this will reduce the inequity in palliative care provision in advanced chronic liver disease.

Keywords: ascites; end-stage liver disease; health-related quality of life; long-term abdominal drains; missing data; palliative care; palliative hepatology; patient reported outcome measures.