Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group.

OBJECTIVE: Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care. DESIGN: A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives. RESULTS: The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided. CONCLUSION: It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD.

An exploratory study of the experiences of deceased-donor liver transplant recipients and their need for psychotherapeutic support.

AIMS AND OBJECTIVES: This study aimed to explore the experiences of liver transplant recipients during their journey through the treatment and their need for psychotherapeutic support related to this process. BACKGROUND: Over time, measures of survival and quality of life in liver transplant recipients have continued to improve but their emotional needs remain under explored. In the longer-term recovery from transplantation, the focus shifts from physical health to psychological health. In the UK, there are no known embedded adult psychological services in liver transplant centres to react to this need. DESIGN: A qualitative descriptive design was used. METHODS: Grounded theory analysis was used to study the narratives of six adult liver transplant recipients. Through a process of coding, conceptual categories were established to describe the participant experiences. The study adhered to the EQUATOR checklist, SRQR. RESULTS: Four categories emerged that were related to the experience of liver transplantation for the recipients. These were a process of adjustment, the phenomenon of waiting, liver transplant as a transformative experience and on the value of support. The participants identified a lack of psychotherapeutic support provided by the liver transplant service and felt that an embedded psychotherapeutic service would promote accessing such support during challenging times. CONCLUSION: Through the process of liver transplantation, recipients experience challenges with adjustment, waiting, feeling transformed and they value support with these feelings. In correlation with other studies, the findings of this study highlight the need for providing psychotherapeutic support within liver transplant services. RELEVANCE TO CLINICAL PRACTICE: The study provides evidence to support recommendations for a conjoined psychotherapy service within liver transplant services to support patients with their holistic needs.

Role of nurses in alcohol screening and treatment interventions.

Alcohol consumption can be a positive factor in many people's social lives, but for some individuals it may cause associated harm to their health. Alcohol consumption can also place a burden on healthcare services. This article explores the trends of alcohol use, primarily in the UK, and outlines the related health effects. The author reviews the screening and brief interventions that non-specialist nurses can use, in partnership with patients, where they have concerns regarding patients' alcohol use and its potentially harmful health effects.

Understanding alcohol-related liver disease patients' illness beliefs and views about their medicine.

BACKGROUND: people with alcohol-related liver disease require complex treatment plans that often include the need for medication for the rest of their lives. Between 30% and 50% of all patients do not take their treatment as prescribed, leading to a significantly increased risk of morbidity and mortality. AIM: to consider the factors which influence beliefs held by patients with alcohol-related liver disease about their medication to provide an evidence base to support interventions to reduce medication non-adherence. METHOD: an observational cross-sectional patient survey. RESULTS: statistically significant associations were found between positive attitudes towards medication and the illness representation dimensions of 'illness identity' and 'illness comprehension'. CONCLUSIONS: medication adherence in patients with alcohol-related liver disease is likely to be improved by an intervention that strives to improve the patient's understanding of their illness condition and their perception of their illness symptoms.

Patients with alcohol-related liver disease--beliefs about their illness and factors that influence their self-management.

AIM: To determine the association between illness belief and self-efficacy to provide the evidence-base to develop a personalized framework to support self-management in patients with alcohol-related liver disease. BACKGROUND: Research in a variety of long-term illnesses suggests patients' illness beliefs are a more influential factor for patient recovery than the severity of the illness. However, research into illness belief and self-efficacy of patients with alcohol-related liver disease is sparse. DESIGN: A cross-sectional survey. METHODS: A cohort of 159 patients with alcohol-related liver disease who attended the Liver Outpatient Clinics at a London Hospital (October 2012-November 2013) completed a set of validated instruments measuring illness beliefs, self-efficacy, emotional states and quality of life. FINDINGS: The mean age of enrolled patients was 52 years, 67% male, 26% live on their own, 61% had no previous history of other chronic illness and average Model for End-Stage Liver Disease and The AUDIT Alcohol Consumption Questions scores were 11·0 and 3·5 respectively. After adjusting for demographic and illness characteristic components, multiple regression analysis shows that the three illness belief components 'Symptoms', 'Understanding' and 'Concerns' made a significant contribution to their confidence to self-manage their liver condition and the 'Symptoms' component makes a signification contribution across to all outcome measures: Anxiety, Depression, Quality of Life and Self-Efficacy. CONCLUSION: Interventions designed to improve these patients' understanding of their illness and strategies to manage their symptoms are likely to improve their self-management, quality of life and reduce anxiety and depression.

Substance use by liver transplant candidates: an anonymous urinalysis study.

Toxicological urinalysis is a highly sensitive and specific test that detects recent substance use. It has been established for substance misuse treatment but has not been routinely used at liver transplantation (LT) centers. Patients with a history of substance misuse are required to be abstinent from alcohol and illicit drugs before they are listed for LT. In this cross-sectional study, we sought to determine the prevalence of recent substance use in LT candidates via toxicological urinalysis. One hundred nine adults who were admitted for an LT assessment provided data, and they were categorized by the etiology of their liver disease [alcohol-related liver disease (ALD), hepatitis C virus (HCV), or other liver diseases]. Urine was toxicologically screened for drugs and their metabolites as well as the urinary alcohol metabolites ethyl glucuronide and ethyl sulfate. The prevalence of alcohol metabolites in patients with ALD was 20%. Licit and illicit substances together provided a positive toxicological result in 30% of the patients. Positive results were more common among patients with HCV (40%) and ALD (38%) versus patients with other liver diseases (18%). During the clinical assessment, 4% of the patients with ALD or HCV self-reported current alcohol or illicit drug use. These results correspond to the findings of other studies and emphasize the uncertainty of self-reported substance use data for LT candidates.