Comment on "Quality of life and unmet needs in patients with chronic liver disease: A mixed-method systematic review".

To the Editor:

Drs. Grønkjær and Lauridsen reported a systematic review of the literature on quality of life with the aim to “reveal unmet patient needs”. The findings of this study added some evidence about unmet needs in patients with chronic liver disease. However, several issues might have compromised the strength of the evidence of this review with regards to unmet needs.

If the authors intended to describe unmet needs of people diagnosed with chronic liver disease, it is unclear why they ignored studies[2], [3], [4], [5], [6] and a systematic literature review specifically focussing on unmet needs of patients with chronic liver disease. The systematic review on unmet supportive care needs in people diagnosed with chronic liver disease published in 2015 identified 26 studies mostly including patients with hepatitis C. Three of these studies included patients with cirrhosis:[4], [5], [6] Bajaj et al. was included in this current review while Zandi et al. and Rakoski et al. were not. If the investigators could have included search terms specifically for unmet needs (e.g. unmet need, support needs, supportive care needs, perceived needs, supportive care, needs assessment) the strength of evidence of this review with respect to unmet needs would have been stronger.

In 2017, we reported the results of a cross-sectional study of unmet supportive needs of 50 people diagnosed with cirrhosis and showed that patients needed support with the management of cirrhosis and its symptoms, emotional issues and abstinence from alcohol and substance abuse. In March 2020, we reported the development and psychometric testing of a Supportive Needs Assessment tool for Cirrhosis (SNAC). The SNAC lists 39 areas of need, separated into 4 subscales – Practical and physical needs, Lifestyle changes, Psychological concerns, and Information needs. Most of the 456 patients (81.1%) included in the study reported that they needed “Some” or “A lot” of additional help with at least one item in the SNAC. The Practical and physical needs and Psychosocial issues subscales had the largest number of items where participants reported that they needed “Some” or “A lot” of additional help. The publications arising from these 2 studies as well as Zandi et al. were listed in PubMed, included the search terms ‘liver disease’, ‘cirrhosis’, and ‘quality of life’, and were published before October 2020. No review can expect to be totally exhaustive, there may always be missing studies, particularly if we consider grey literature. If the investigators could have included all eligible studies, and extracted data more meticulously, the strength of evidence of this review would have been more comprehensive.

Financial support

The authors received no financial support to produce this manuscript.

Authors' contributions

Conceptualization and draft of the letter: PCV. Critical revision for important intellectual content: EEP.

Conflict of interest

The authors declare no conflicts of interest that pertain to this work.

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