Early Palliative Care Integration in End-Stage Liver Disease: A Narrative Review of Clinical Strategies for Symptom Control and Quality of Life

Abstract

End-stage liver disease (ESLD) is associated with a high symptom burden, poor prognosis, and limited access to curative disease. Despite growing evidence supporting the role of palliative care (PC), its integration into the routine management of ESLD remains limited and inconsistent. To synthesize the current evidence on the role of palliative care in ESLD, emphasizing its impact on quality of life and including strategies for symptom control and effective clinical integration. A narrative review with a systematic approach was conducted. PubMed, Scopus, Embase, and SciELO were searched for English- and Spanish-language studies published between 2015 and 2025. Studies were selected based on methodological rigor and relevance to PC interventions in ESLD. Key barriers to PC implementation include misconceptions about its use being limited to terminal phases, lack of referral criteria, and insufficient coordination between specialties. Evidence shows that early PC involvement improves symptom control (pain, dyspnea, pruritus, encephalopathy), decreases avoidable hospitalizations, and facilitates shared decision-making. Early and structured integration of palliative care into ESLD management is essential. Health systems should prioritize interdisciplinary care models, establish clear referral criteria, and promote a care approach focused on patient well-being, autonomy, and dignity.