{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:43:22Z","timestamp":1791927802368,"version":"4.3.4"},"reference-count":23,"publisher":"Springer Publishing Company","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Doct Nurs Pract"],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:p>\n                  <jats:bold>Background:<\/jats:bold> Liver disease is often associated with high symptom burden and long hospital stay, leading to a decreased quality of life. For patients considered unsuitable for transplantation, the alternative treatment options are supportive management and palliative care (PC). The most significant barrier to early PC is the failure to identify patients who may benefit from it. Currently, transplant healthcare professionals have limited PC education as well as a limited understanding of primary PC and PC service flow. <jats:bold>Objective:<\/jats:bold> The purpose of this quality improvement (QI) project is to identify nontransplantable liver disease (NTLD) patients\u2019 unidentified unmet PC needs, utilizing two validated tools Necesidades Paliativas Palliative Needs (NECPAL) and Chronic Liver Disease Questionnaire (CLDQ), and integrate them within routine nursing care activities in the transplant unit to increase pain and symptom management. <jats:bold>Methods:<\/jats:bold> This Doctor of Nursing Practice (DNP) project was integrated into a QI project over 12 weeks in the Fall of 2019. Transplant nurses and nurse practitioners (NPs) completed the tools for every NTLD patient to identify patients in need of PC and to assist identification of end-of-life symptoms to determine the quality of life. <jats:bold>Results:<\/jats:bold> A total of 5 NPs and 10 staff nurses received education and training on the NECPAL and CLDQ tools from the DNP project leader. Sixteen nontransplant liver disease patients, aged 29\u201368 years, median age of 52 years, majority being (69%) female, participated. The percentage of patients who completed the CLDQ and reported symptoms of unmet needs was an average of 80%. The most common symptoms reported were abdominal bloating and discomfort, worrying, and family impact. The goal was for all nurses and NPs to complete the screen tool 100% of the time. The percentage of patients completing the NECPAL, at an average of 60%, indicated a need for integrating PC. <jats:bold>Conclusions:<\/jats:bold> Implementation of NECPAL and CLDQ tools identified multiple unmet PC needs in NTLD patients. Nurses and NPs reported the tool was easy to use in identifying symptoms and clinical indicators for the identification of unmet PC needs and to promote incorporation into routine nursing care in liver disease patients who were deemed nontransplantable and allowed nurses to advocate for symptom and pain management with objective validated tools. <jats:bold>Implications for Nursing:<\/jats:bold> The NECPAL and CLDQ screening tools can identify clinical symptoms and the need for integration of PC. Incorporating PC needs promotes optimal end-stage quality of life for patients and their families. Ongoing training for NPs and nursing staff is needed to continue providing identification of patient PC needs. These nurse-initiated screening PC tools can be easily implemented in other units caring for patients with chronic and\/or end-stage diseases to improve symptom management and end-of-life care.<\/jats:p>","DOI":"10.1891\/jdnp-2021-0004","type":"journal-article","created":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T21:10:33Z","timestamp":1717535433000},"page":"143-153","source":"Crossref","is-referenced-by-count":1,"title":["Integration of Palliative Care Screening Tools for End-Stage Liver Patients to Improve End-of-Life Care"],"prefix":"10.1891","volume":"18","author":[{"given":"Susanne","family":"Gaines","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemarie D.","family":"Satyshur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanna","family":"Fitzpatrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"793","published-online":{"date-parts":[[2024,6,4]]},"reference":[{"issue":"5","key":"2025081818050995000_18.2.143.1","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1089\/jpm.2017.0339","article-title":"Intrahospital mortality and survival of patients with advanced chronic illnesses in a tertiary hospital identified with the NECPAL CCOMS-ICO\u00a9 tool","volume":"21","author":"Calsina-Berna","year":"2018","journal-title":"Journal of Palliative Medicine"},{"key":"2025081818050995000_18.2.143.2","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000000593"},{"issue":"7","key":"2025081818050995000_18.2.143.3","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.nurpra.2022.04.011","article-title":"Improving hospice and palliative care through nurse practitioner engagement in a community paramedicine program","volume":"18","author":"Fitzpatrick","year":"2022","journal-title":"The Journal for Nurse Practitioners"},{"key":"2025081818050995000_18.2.143.4","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2014.001487"},{"issue":"8","key":"2025081818050995000_18.2.143.5","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1177\/0269216316676647","article-title":"Utility of the NECPAL CCOMS-ICO\u00a9 tool and the surprise question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study","volume":"31","author":"G\u00f3mez-Batiste","year":"2017","journal-title":"Palliative Medicine"},{"issue":"5","key":"2025081818050995000_18.2.143.6","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1002\/nur.21807","article-title":"Background and design of the symptom burden in end-stage liver disease patient-caregiver dyad study","volume":"40","author":"Hansen","year":"2017","journal-title":"Research in Nursing & Health"},{"issue":"2","key":"2025081818050995000_18.2.143.7","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S2468-1253(17)30396-5","article-title":"Palliative care in liver disease: A matter of life and death","volume":"3","year":"2018","journal-title":"The Lancet. Gastroenterology & Hepatology"},{"key":"2025081818050995000_18.2.143.8","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2016-100734"},{"issue":"1","key":"2025081818050995000_18.2.143.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12904-017-0217-9","article-title":"Strengthening primary health care teams with palliative care leaders: protocol for a cluster randomized clinical trial","volume":"17","author":"Llobera","year":"2017","journal-title":"BMC Palliative Care"},{"issue":"7","key":"2025081818050995000_18.2.143.10","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1002\/lt.25193","article-title":"Palliative care in end-stage liver disease: Time to do better? Liver transplantation","volume":"24","author":"Mazzarelli","year":"2018","journal-title":"Liver Transplantation"},{"key":"2025081818050995000_18.2.143.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.j878","article-title":"Palliative care from diagnosis to death","volume":"356","author":"Murray","year":"2017","journal-title":"BMJ (Clinical Research Ed.)"},{"key":"2025081818050995000_18.2.143.12","doi-asserted-by":"publisher","DOI":"10.1097\/00005110-200607-000-00001"},{"issue":"1","key":"2025081818050995000_18.2.143.13","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1002\/cld.482","article-title":"Is palliative care appropriate in the liver transplant candidate","volume":"6","author":"Pai","year":"2015","journal-title":"Clinical Liver Disease"},{"issue":"11","key":"2025081818050995000_18.2.143.14","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1089\/jpm.2013.0167","article-title":"Integration of palliative care in end-stage liver disease and liver transplantation","volume":"17","author":"Potosek","year":"2014","journal-title":"Journal of Palliative Medicine"},{"issue":"8","key":"2025081818050995000_18.2.143.15","article-title":"Palliative care referrals still low in hospitalized patients with end-stage liver disease in the USA","volume":"78","author":"Rush","year":"2017","journal-title":"British Journal of Hospital Medicine"},{"issue":"1","key":"2025081818050995000_18.2.143.16","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/13607860903046495","article-title":"Integrating unmet needs into dementia health-related quality of life research and care: Introduction of the hierarchy model of needs in dementia","volume":"14","author":"Sch\u00f6lzel-Dorenbos","year":"2010","journal-title":"Aging & Mental Health"},{"issue":"2","key":"2025081818050995000_18.2.143.17","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1097\/NNA.0b013e31827f20a9","article-title":"Lewin\u2019s theory of planned change as a strategic resource","volume":"43","author":"Shirey","year":"2013","journal-title":"JONA"},{"issue":"13","key":"2025081818050995000_18.2.143.18","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.3748\/wjg.v10.i13.1954","article-title":"Chronic liver disease questionnaire: Translation and validation in Thais","volume":"10","author":"Sobhonslidsuk","year":"2004","journal-title":"World Journal of Gastroenterology"},{"issue":"1","key":"2025081818050995000_18.2.143.19","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1007\/s10620-016-4339-3","article-title":"Palliative care quality indicators for patients with end-stage liver disease due to cirrhosis","volume":"62","author":"Walling","year":"2017","journal-title":"Digestive Diseases and Sciences"},{"issue":"2","key":"2025081818050995000_18.2.143.20","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1177\/082585971503100208","article-title":"What diagnostic tools exist for the early identification of palliative care patients in general practice? A systematic review","volume":"31","author":"Walsh","year":"2015","journal-title":"Journal of Palliative Care"},{"issue":"5","key":"2025081818050995000_18.2.143.21","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.jfma.2018.10.004","article-title":"Validation of a concise screening tool for the identification of palliative care needs among Inpatients: A prospective study in hospital setting","volume":"118","author":"Wang","year":"2019","journal-title":"Journal of the Formosan Medical Association"},{"key":"2025081818050995000_18.2.143.22","doi-asserted-by":"publisher","DOI":"10.1136\/gut.45.2.295"},{"issue":"1","key":"2025081818050995000_18.2.143.23","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1002\/cld.480","article-title":"Overall health-related quality of life in patients with end-stage liver disease","volume":"6","author":"Younossi","year":"2015","journal-title":"Clinical Liver Disease"}],"container-title":["Journal of Doctoral Nursing Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1891\/JDNP-2021-0004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T01:05:22Z","timestamp":1755565522000},"score":1,"resource":{"primary":{"URL":"http:\/\/connect.springerpub.com\/lookup\/doi\/10.1891\/JDNP-2021-0004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,4]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,8,14]]},"published-print":{"date-parts":[[2025,8,1]]}},"alternative-id":["10.1891\/JDNP-2021-0004"],"URL":"https:\/\/doi.org\/10.1891\/jdnp-2021-0004","relation":{},"ISSN":["2380-9418","2380-9426"],"issn-type":[{"value":"2380-9418","type":"print"},{"value":"2380-9426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,4]]}}}