Priorities in relapse prevention for patients with alcohol-related cirrhosis: a national expert consensus building study involving patients and carers

Background: Alcohol use is the primary determinant of outcome for patients with decompensated alcohol-related cirrhosis. It is vital to determine the best ways to support patients in remaining abstinent. Methods: A short survey was conducted of stakeholders including specialists in hepatology and alcohol use disorder, as well as individuals with lived experience and their carers. We asked about the facilitators and barriers to abstinence following a hospital admission. An expert steering group integrated the survey findings with other sources of evidence to produce a list of potential recommendations to optimise relapse prevention. Stakeholders were asked to rate and then rank these recommendations. Results: 188 stakeholders identified a wide range of themes at the survey stage. 48 recommendations were generated, of which 37 achieved consensus. The five recommendations achieving the highest rankings were: 1. Relapse prevention work should be presented as a routine part of the care of patients with alcohol-related cirrhosis. 2. Patients should be offered medications for alcohol use disorder prior to discharge. 3. Before discharge from hospital patients should be provided with clear information about their liver disease and the risks of future alcohol use. 4. Community alcohol services should see patients within two weeks of discharge. 5. Patients should be directly referred by the hospital team for relapse prevention treatment. Four of the top five overall recommendations were also in the top 5 for patients and carers. Conclusion: Stakeholders identified that relapse prevention, including the use of pharmacotherapies, clear information, and prompt follow-up, should be prioritised as routine standard of care for all patients with alcohol-related cirrhosis.