Barriers to accessing palliative care in advanced liver disease

Abstract

This study analyzed, from a bioethical perspective and through an integrative review, the barriers to
accessing palliative care for patients with advanced liver disease. The guiding research question was:
“What are the barriers to accessing palliative care for these patients across different levels of healthcare?”
The literature search was conducted in the Medline/PubMed and Scopus databases using descriptors
related to palliative care and end-stage liver disease. After screening 410 articles, 27 studies published
between 2019 and 2024 were included and qualitatively analyzed. The barriers identified were
classified into three categories: patient-related, physician-related, and institutional. Among patients,
the main barriers included the association of palliative care with end-of-life care, limited understanding
of prognosis, and fear of losing the opportunity for liver transplantation. For physicians, important
barriers included prognostic uncertainty, transplant eligibility concerns, and limited availability
of palliative care specialists. At the institutional level, the main challenges were the lack of outpatient
palliative care clinics, insufficiently trained professionals, and the absence of automated care processes.