Opportunities and challenges for a person-centered approach to viral hepatitis

Abstract

Viral hepatitis is a major cause of mortality and morbidity, accounting for the majority of end-stage liver disease and being the most common underlying cause of liver transplantation. Despite significant progress in the understanding of the etiology and pathophysiology of the disease, several factors relating to the disease’s clinical expression remain unclear. In particular, the significant variety in clinical phenotypes post-exposure, as well as the unjustified differentiation in the natural history of the chronic stage of the disease, remain to be explained. At the same time, the biomedical paradigm fails to take other aspects of the disease into account, in particular those pertaining to its significant social and cultural consequences and their contribution to the total disease burden for the patient. In reality, the effects of the disease in the individual’s professional life, family serenity and community acceptance may be so detrimental that they can surpass the biological consequences per se in terms of their impact on loss of quality of life. Thus, it might be justified to re-examine the current management of the disease by applying the biopsychosocial model of care and the person-centered approach to the affected individual. In this context, a multi-disciplinary team is available to support the patient in his/her various needs and the content, structure and duration of therapy is tailored to his/her specific demands. Treatment success or failure cannot be determined  solely by biological criteria, but rather via short- and long-term goals agreed in advance by the patient and his clinicians/carers and evaluated in a systematic manner.