Sorrow, Unpermitted: A Narrative Review of Grief in Chronic Liver Disease.

Chronic liver disease, currently the 9th leading cause of death in the U.S., creates complex medical and psychosocial challenges. Individuals with liver disease, their caregivers, and their clinicians may be affected by this illness, and at risk for challenging grief experiences. However, grief in chronic liver disease has been underexplored. The purpose of this narrative review was to examine the grief experiences of adults with chronic liver disease, their caregivers, and their clinicians. Embase, Medline, Web of Science, CINAHL, PsycINFO, and Social Sciences online databases were searched resulting in a total of 11 included articles. 12 themes emerged capturing the unique grief in chronic liver disease: seven themes pertaining to observations of grief; including wide-ranging emotions, multifaceted losses and social isolation, unique patient age profile, stage of life, and intersections with substance use, stigma, (prognostic) uncertainty, unique caregiver burden and grief, and the need for quality palliative and/or end-of-life care, and five themes pertaining to interventions in grief; including the role and benefit of palliative care, advance care planning, interdisciplinary support, hospice, and other strategies. Findings highlight a need for interventions and further research to improve the grief experiences of people with chronic liver disease and their personal and professional caregivers.