Abstract
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Background: Patients with advanced Hepatocellular Carcinoma (HCC) and decompensated cirrhosis often experience disease progression, acute complications, poor prognosis, and complex care needs. This case describes the role of a Nurse Practitioner (NP) in multidisciplinary care coordination and Advance Care Planning (ACP) to support patient centered care and transition to palliative care.
Case Presentation: A 59-year-old man with chronic hepatitis c, diabetes mellitus, and previous ischemic stroke had a hepatic nodule and elevated Alpha-Fetoprotein (AFP) identified in 2024 but did not complete subsequent evaluation or regular follow-up. He later presented with abdominal distension and melena and was diagnosed with decompensated cirrhosis complicated by esophageal variceal bleeding, ascites, and advanced HCC with portal vein tumor thrombosis. His condition progressed to child-Pugh class c, Eastern Cooperative Oncology Group (ECOG) performance status 3, and Barcelona Clinic Liver Cancer (BCLC) staged.
NP Intervention: The NP provided whole-person assessment and coordinated gastroenterology, critical care, nutrition, rehabilitation, social work, and palliative care. Early recognition of clinical deterioration facilitated endoscopic hemostasis and hemodynamic stabilization. The NP assessed psychosocial needs, caregiver burden, and social support and facilitated family meetings to promote shared understanding of disease progression and goals of care. As treatment options became limited, the NP initiated ACP and facilitated discussions regarding prognosis, treatment preferences, quality of life, end-of-life care, and future care settings. Following shared decision-making, the patient completed an advance directive (ad) and Do-Not-Resuscitate (DNR) decision according to his preferences.
Outcome and Conclusion: Goals of care shifted from disease-directed treatment to symptom management and best supportive care. Following ACP, ad, and DNR decision making, the patient was transferred to a long-term care facility for continued palliative care. This case demonstrates the NP’s role in multidisciplinary care coordination, communication, shared decision-making, and ACP, supporting continuity of care and goal-concordant transition to palliative care.
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