Jun 14, 2021

Nancy Reau, MD, FAASLD
Nancy Reau, MD, FAASLD

Healthcare providers are increasingly called upon to help their patients separate half-truths from hard science in the information they come across related to their treatment and disease management. Helping people with liver disease to navigate the evolving understanding of COVID-19 and to overcome vaccine hesitancy are just the latest challenges on this front.

For almost a year and a half, providers have been adjusting to additions to the knowledgebase regarding COVID-19 risk, prevention, diagnosis, and treatment.

“Our patients definitely struggle with having information that might’ve been reasonable information at one point, but is now out of date,” said Nancy Reau, MD, FAASLD, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center. “Having a chronic disease leads to considerable insecurity. Our patients are afraid that getting infected with COVID-19 will cause them to become critically ill, but they’re also afraid of vaccination and worry that their liver medications might allow a COVID infection to become more serious. We need to help them reconcile these fears and encourage them to remain on the medications that keep their liver disease stable.”

Daily, hepatologists have been faced with balancing how to protect their patients from worsening liver disease while also protecting them from COVID-19. Oren Fix, MD, MSc, FAASLD, Co-Chair of the AASLD Clinical Oversight and Education Subcommittee, said many patients have avoided needed care during the pandemic out of fear of being exposed to COVID-19.

Oren Fix, MD, MSc, FAASLD
Oren Fix, MD, MSc, FAASLD

“Unlike a lot of other generally healthy patients who can avoid seeing their doctors or primarily see their doctors through telemedicine, patients with liver disease can’t afford to wait,” said Dr. Fix, University of North Carolina. “They have unique preventive issues that need to be addressed before they become urgent issues.”

Dr. Reau said there are two key messages providers want people with liver disease to know about COVID-19: It doesn’t have significant liver-related signals, and vaccination against COVID-19 is encouraged.

“COVID doesn’t seem to cause liver disease, and most people with liver disease, as long as they have good functioning livers, even if they’re post-transplant or have autoimmune disease or chronic hepatitis, they tend to do well if they get the infection,” Dr. Reau said.

Patients are hungry for this and other information they can apply to their own care. But even when viruses like SARS-CoV-2 make headlines, Dr. Fix said patients often come up empty-handed after listening to news reports or doing their own internet research, underscoring the importance of the role of counseling from their healthcare team. The AASLD provides guidance on this through documents such as Counseling Liver Disease Patients about COVID-19 Vaccination.

Elizabeth K. Goacher, PA-C, MHS, AF-AASLD
Elizabeth K. Goacher, PA-C, MHS, AF-AASLD

Provider-patient conversations represent one of the most powerful tools physicians have for patient education, said Elizabeth K. Goacher, PA-C, MHS, AF-AASLD, a member of the writing group for the above-mentioned document. Goacher, a physician assistant in gastroenterology at Duke University, also is Chair of the AASLD Hepatology Associates Committee.

“There’s data to support that healthcare providers make an impact in just communication,” she said. “Sometimes we feel like we have to do something like write a prescription, give a therapeutic, do a procedure, but really, our voices are one of our best resources.”

Earlier this year, the AASLD produced a webinar co-moderated by Goacher entitled “Fact vs. Fiction: What Patients with Chronic Liver Disease Want to Know about COVID-19.” The one-hour session, which continues to be available for viewing online, contributes to the association’s growing focus on patient-centered resources as well as its commitment to providing the most up-to-date resources on the interplay of COVID-19 and liver disease. Drs. Reau and Fix were among the panelists for the webinar.

The second half of “Fact vs. Fiction”, featuring questions from an audience of patients, offers important insights for hepatologists, Goacher noted.

“It’s helpful for providers to see the questions from the audience, so that they can help address them in their clinic proactively,” she said. “I think we underestimate the degree of poor education people may have. They may have accessed biased sources. We rant and rave about ‘Dr. Google’ and how it leads people astray, but we don’t then tackle that head on.”

Providers tend to assume people are prepared to ask the right questions, and when patients and caregivers don’t ask these questions, the assumption is that they know the answers, she continued.

“We need to be humble in our approach and remember that there are questions that we would never have thought of because of where we are as healthcare providers,” Goacher said. “We need to have our patients engage with us in order to keep us on the level that we need to be addressing.”

The AASLD generates reliable information for patients as well as providers and serves as a liaison to other reliable sources like the National Institutes of Health (NIH) or the Centers for Disease Control and Prevention (CDC).

In addition to drafting literature and recording webinars on COVID-19 and the Liver, the AASLD has worked with patients to create a series of fact sheets addressing the unique concerns related to COVID-19 and different kinds of liver patients that can be downloaded and shared. Dr. Reau said the hope is that by the end of the year, most of the AASLD practice guidelines will have patient resources associated with them.

Provider awareness of these resources is critical to connecting patients to this expanding library.

“It’s our responsibility to push reliable information towards our patients,” Dr. Reau said. “They don’t necessarily have to read it, but we should be the one telling a patient that this is a credible place to find information.”

Many patient-facing resources created by the AASLD can be found on the AASLD Foundation website alongside links to outside organizations.