Background Liver cirrhosis (LC) is a progressive disease characterised by chronic liver inflammation, leading to diminished liver function and complex symptomatology. As LC advances to decompensated cirrhosis and end-stage liver disease (ESLD), patients experience severe symptoms such as pain, ascites and encephalopathy, significantly impairing their quality of life. Despite the high symptom burden and a substantial mortality rate, palliative care remains grossly underused.

Objective This review aims to explore the current state of palliative care utilization in ESLD patients, identify barriers to palliative care access, and discuss strategies for enhancing symptom management and improving patient quality of life.

Design A comprehensive literature review was performed of palliative care in liver cirrhosis, symptom prevalence, management strategies, and barriers to palliative care consultation.

Methods and data sources Our review synthesized information from 49 referenced sources, covering symptom management, healthcare utilization, and palliative care approaches with regards to liver cirrhosis.

Findings We find significant underutilization of palliative care services, with consultation rates as low as 0.97% for patients with decompensated cirrhosis. Key barriers include liver transplant eligibility, racial disparities, and lack of insurance coverage.

Conclusion Despite evidence suggesting that palliative care improves patient outcomes and quality of life, its implementation in patients with ESLD remains insufficient. Increasing awareness and integration of palliative care into routine management for these patients are crucial. The concept of primary palliative care is proposed as a means to bridge the gap until specialised services are available, allowing all clinicians contribute to alleviating patient suffering and improving overall care.