Care in the community for patients with advanced liver disease

Liver disease is one of the most pressing challenges facing the NHS today. Michelle Brown and Gerri Mortimore look at how this condition can be assessed and managed by nurses working in primary care. This article focuses on liver disease, its increasing prevalence and associated mortality. It will discuss how liver cirrhosis leads to the development of portal hypertension and the many complications associated with this, along with the increased risk of developing liver cancer. This makes treatment, management, and care for patients with liver cirrhosis complex. It is important that loved ones and health care professionals have the time and an ability to respond to changes in the patient's condition, and journey through to end-of-life. This is paramount to ensure a dignified death. However, advanced liver disease can mean that these conversations, preparation, and decisions may not be possible due to the rapid progression of disease. This article will reflect on these difficult conversations and the preparation for the reality of dying in a community setting with what often features a complex symptom presentation and treatment.