🏅Your Path to Certification
Earn your way up three evidence-based tiers. Each builds on the last. Finish all three and receive your Certified Prepared Patient · Cirrhosis badge and printable certificate, recognized across the FFH Network.
Aware · Identity: Self-Advocate
You know your body and your disease. Layer 1 — Condition Literacy.
- Complete Modules 1–4 (Condition Literacy)
- Pass the "What Cirrhosis Is" quiz (≥80%)
- Identify your cause (MASH/alcohol/viral B-C/autoimmune/other), compensated vs decompensated status, MELD-Na, Child-Pugh, current med stack, and HCC ultrasound + variceal screening schedule
- Build your daily weight + abdominal girth log + MELD-Na trend tracker with the FFH "Notice and Name" framework
Active · Identity: Care Team Member
You partner with your team and navigate the system. Layer 2 — Care & System Literacy.
- Complete Modules 5–7 (Make Every Visit Count · When to Call vs ED · Comorbidity Awareness)
- Demonstrate teach-back on your treatment plan, NSAID-absolute / acetaminophen-limited rules, and your "when to call vs 911" decision rule for the four decompensation events
- Complete one "great visit" prep + debrief
- Build your When-to-Call plan + Care Team card; if alcohol-related, addiction-medicine connection complete
- Successfully resolve one prior auth (DAA for Hep C / GLP-1 for MASH / resmetirom), copay-help application, or hepatology care-navigator engagement
Certified Prepared Patient · Identity: Ambassador
You teach, mentor, fight stigma, and shape research & policy. Layer 3 — Advocacy & Ambassadorship.
- Complete Modules 8–10 (Family & Care Team · Talk to Kids/Partner/Employer + Mentor · Mastery & Graduation)
- Mentor 1 newly-diagnosed person or family via American Liver Foundation OR present at a hepatology-clinic / addiction-medicine / faith-community education session
- Sign the Prepared Patient Pledge
- Complete advance care planning (POA, proxy, advance directive, POLST/MOLST, will) — important across the cirrhosis arc, especially before HE compromises capacity
- Submit one advocacy action (story, feedback letter, MASH-vs-alcoholic stigma piece, Hep C universal-screening advocacy, transplant-equity policy comment)
📋Master Pre / Post Assessment
Where You Stand — Confidence Before & After
Seven dimensions of being a Prepared Patient. Answer once at the start of your journey and again at the end. Your goal is to see real growth across understanding, self-management, communication, and optimal utilization — knowing when to call your team, when to use Day Hospital, and when to go to the ER. Your answers stay on this device unless you choose to share with your clinician.
📈 Your Pre→Post Growth
📞Know Who to Call — Before the ER
Cirrhosis care runs as a long arc — compensated stable phase, then (sometimes) decompensation, then transplant pathway or maintenance. Most days are routine. Some days bring lab/medication calls. The four classic decompensation events — variceal bleeding, ascites, HE, jaundice — and SBP infection deserve recognition cold. Knowing the right number to call — your hepatology team, the ALF helpline, or 911 — saves time, dignity, and life. Save these numbers in your phone today. The numbers below are placeholders — your institution will fill in the right ones for you.
🚨 Vomiting blood, dark/tarry stools, severe confusion, severe abdominal pain with fever — 911
Vomiting blood (hematemesis) or passing dark/black/tarry stools (melena) = 911 — variceal bleeding is life-threatening. Severe confusion, can't be awakened, posturing (severe HE) = 911. Severe abdominal pain + fever + ascites (suspected SBP) = ED. Fall with head injury in someone with HE risk = 911. Severe jaundice + new confusion + worsening over hours = 911.
🧭 New swelling, mild HE signs, jaundice, weight gain, fever — call before the ED
For new abdominal swelling or rapid weight gain (>2 lb/day), early HE signs (sleep changes, mild confusion, asterixis — family typically sees first), new jaundice, fever without severe pain, or medication-safety questions (especially around NSAIDs, acetaminophen, or contrast), call your [Hepatology Triage Line: (555) 123-4567]. Most issues are addressable in clinic.
💬 Routine questions, refills, scheduling, caregiver + addiction support
Use [MyChart portal] first — most messages answered within 1 business day. For DAA (Hep C) / antiviral (Hep B) / NSBB / lactulose-rifaximin refills or copay help, call [Specialty Pharmacy: (555) 222-9050]. For peer mentoring, transplant-pathway questions, and local resources, call the American Liver Foundation helpline 1-800-465-4837 — free, real humans, weekdays. For alcohol cessation: SAMHSA helpline 1-800-662-HELP (4357).
🚑 Call 911 right away for any of these
Vomiting blood · black/tarry stools · severe confusion or can't be awakened · severe abdominal pain with fever (suspected SBP) · fall with head injury · severe jaundice with new confusion · chest pain · severe shortness of breath · suspected sepsis (fever + rigors + low BP, especially after a procedure or paracentesis) — 911.
📚Condition Literacy & the 10 Prepared Patient Competencies
A Prepared Patient builds three kinds of health literacy — and grows into three identities. Each competency works through the FFH three pillars: Learn It · Live It · Share It.
Advocate for Self
You speak up for your own care, plan, pain, and goals.
Care Team Member
You partner with your team — not above, not below.
Ambassador
You teach, mentor, and shape research, policy & access.
🧬 Condition Literacy Learn It · Tier 1 Aware
"I know my body and my disease." The foundation. Without this, nothing else holds.
What Cirrhosis Is
End-stage scarring of the liver from chronic injury. Compensated vs decompensated is the key distinction. Four decompensation events: variceal bleeding, ascites, HE, jaundice. Causes: MASH (now leading), alcohol, viral B/C, autoimmune. Hep C is curable.
Know My Numbers & Risk Factors
MELD-Na (transplant priority — bilirubin + INR + creatinine + sodium), Child-Pugh A/B/C, AFP for HCC, platelets, albumin, INR, bilirubin, sodium. Cause-specific markers (Hep B viral load, Hep C cured?, ferritin, autoimmune antibodies). ALT/AST may be NORMAL in advanced cirrhosis.
Lifestyle Force Field — Alcohol Cessation, Weight, Vaccines, Food Safety, Med Safety
Alcohol cessation: immediate, lifelong, regardless of cause. Weight loss 5–10% for MASH. Vaccinations (Hep A, Hep B, flu, pneumo, COVID, RSV, Shingrix). Avoid raw shellfish (Vibrio). NSAIDs absolute NO; acetaminophen ≤2 g/day (less if drinker). Adequate protein (do NOT extreme low-protein). Modest sodium <2 g/day if ascites.
Medications — Cause-Specific + Symptom Management
Hep C: now curable with DAAs (8–12 weeks, sofosbuvir/velpatasvir). Hep B: long-term antivirals (entecavir, tenofovir). Autoimmune: steroids ± azathioprine. MASH: GLP-1s + resmetirom + weight loss. Alcohol-associated: cessation is the therapy; naltrexone/acamprosate support. NSBBs for varices, lactulose+rifaximin for HE, diuretics for ascites. Statins safe.
🤝 Care & System Literacy Live It · Tier 2 Active
"I'm part of the team. I navigate the system." Where most preventable ED visits, decompensation crises, and frustration happen — and where this course pays off the most. Optimal utilization lives here.
Make Every Visit Count — SHARE Approach + Teach-Back
AHRQ SHARE Approach (Seek, Help, Assess, Reach, Evaluate). Teach-back at every visit. 3-question max written priority list. Numbers card + med list + second pair of ears. Oncology visits are complex; preparation multiplies value.
When to Call vs Go to ED — Decompensation Events, SBP, HE
Vomiting blood / dark stools = 911 (varices). Severe confusion / can't be awakened = 911 (severe HE). Fever + abdominal pain in ascites = ED (SBP). New swelling, mild HE signs (family sees first), new jaundice = same-day hepatology call. Falls with HE = 911 if head injury. Most issues are addressable in clinic.
Comorbidity Awareness — HCC, SBP/Infection, Hepatorenal, Sarcopenia, Depression, Sleep, Falls
Cirrhosis-specific Module 7. The hepatic outcome of the metabolic + lifestyle + viral cluster — T2D-driven MASH is the leading cause (cluster module CROSS-REFERENCED, not embedded). HCC constant background risk (~2–4%/yr). Infection susceptibility (SBP, line infections, pneumonia). Hepatorenal syndrome / CKD. Depression >30%. Sleep disorders. Frailty/sarcopenia. Falls (esp. HE-related). Osteoporosis.
📣 Advocacy & Ambassadorship Share It · Tier 3 Certified
"I speak up. I lift others. I shape the future." This is what turns a Prepared Patient into a force multiplier for the whole community.
Family, Caregiver, and the Care Team — HE-Recognition Role + Transplant Pathway
The family caregiver helps with daily weight + abdominal girth, medication tracking, alcohol-cessation support if relevant, NSAID-avoidance + acetaminophen-limit vigilance, and the HE-recognition role (loved one sees confusion before patient does). Team: hepatology + GI + PCP + RN + hepatology dietitian + pharmacist + social work + addiction medicine (if alcohol) + behavioral health + ALF peer + transplant team. Refer to transplant by MELD ~15 or first decompensation.
Sharing — Talk to Kids, Partner, Employer; Stigma; Mentor
Kids: plain language about cause and plan. Partner: alcohol-cessation support if relevant; HE-recognition role; not-driving-with-HE conversation. Employer: ADA covers cirrhosis; HE flares need cognitive accommodations; transplant recovery 6–12 weeks. Most patients return to work. Stigma cuts both ways (alcoholic + MASH) — both deserve compassion. ALF for mentoring. FFH "Notice and Name" — observation, never diagnosis.
Mastery & Graduation — Cause-Specific Treatment, Transplant Readiness, ACP, SBP Vigilance
Cause-specific treatment held steady (alcohol cessation, weight loss for MASH, Hep C cured, Hep B suppressed, autoimmune controlled). Pre-emptive transplant readiness or peace with palliative path. Advance care planning while capacity is clear (HE may compromise it). Caregiver wellness plan. ALF peer mentoring active. SBP / infection vigilance. Earn Certified Prepared Patient · Cirrhosis.
👥My Care Team
Your team is bigger than just the doctor — and the care partner is part of it. Click any card to edit, or click the + tile to add a new team member. Saved on this device. The Force Field Emergency Card below auto-syncs from this list. Starter roster pre-populated for cirrhosis — your institution can edit any row. The Force Field Emergency Card auto-syncs from this list.
📖Glossary — words you'll hear
Plain-English definitions for terms doctors and labs use. Tap to expand.
Cirrhosis
MASH / NAFLD / MAFLD
Hepatic Encephalopathy (HE)
Variceal bleeding
Ascites
SBP (Spontaneous Bacterial Peritonitis)
MELD-Na score
Child-Pugh score
HCC (Hepatocellular Carcinoma)
DAA (Direct-Acting Antivirals) for Hep C
NSBB (Nonselective Beta Blocker)
Lactulose + Rifaximin
Spontaneous Hepatorenal Syndrome (HRS)
Liver transplant
🧪Lab Test Tutor — what your numbers mean
Lab Test Tutor — what your numbers mean
Don't just see a number — know what it means and what to ask. Your "normal" may be different from a friend's. Ask your team to write your personal baseline in the column on the right.
| Test | What it measures | Typical adult range | What to ask if it's off | My baseline |
|---|---|---|---|---|
| MELD-Na score | Transplant priority score (bilirubin + INR + creatinine + sodium). Higher = sicker = higher on the transplant waitlist. The single most important number in transplant evaluation. | 6–40+ | What's my current MELD-Na? Is it changing? Where am I on the transplant pathway? | [fill in] |
| Child-Pugh score (A/B/C) | Classic cirrhosis prognostic score. Combines albumin, bilirubin, INR, ascites, encephalopathy. Class A = well-compensated; B = compromised; C = decompensated. | Class A: 5–6 pts · B: 7–9 · C: 10–15 | What's my Child-Pugh class? What changes with progression? | [fill in] |
| AFP + ultrasound (HCC surveillance) | Alpha-fetoprotein + liver ultrasound every 6 months. The standard HCC surveillance in cirrhosis. Catch tumors early when they're treatable. | AFP <10 ng/mL normal; ultrasound = no new lesion | Is my surveillance on schedule? Any new lesions? | [fill in] |
| Platelet count | Low platelets = portal hypertension marker. Below 150K is suggestive; below 100K is significant; below 50K can complicate procedures. | 150–400 K/μL | What's my platelet count? Any procedure-bleeding precautions? | [fill in] |
| Albumin | Made by the liver. Low albumin = synthetic failure + edema/ascites driver. One of the Child-Pugh components. | 3.5–5.0 g/dL | Is my albumin trending down? Should I get IV albumin with paracentesis? | [fill in] |
| INR | Reflects clotting-factor synthesis (made by the liver). High INR = synthetic failure. Do not confuse with anticoagulation INR target. One of the MELD-Na components. | ~1.0 (untreated baseline); cirrhosis often elevated | What's my INR baseline? Any procedure-bleeding precautions? | [fill in] |
| Bilirubin (total) | Reflects liver excretion. High = jaundice. One of the MELD-Na components. | 0.3–1.2 mg/dL | Is my bilirubin trending up? When does jaundice become visible? | [fill in] |
| Creatinine + sodium | Kidney function (creatinine) and portal-hypertension severity (sodium — low Na in advanced cirrhosis). Both components of MELD-Na. | Creatinine 0.6–1.2 mg/dL · Na 135–145 mEq/L | Is my creatinine rising (hepatorenal risk)? Is my Na low (advanced disease)? | [fill in] |
| ALT / AST | Liver inflammation enzymes. Elevated in active hepatitis. May be NORMAL in advanced cirrhosis — don't be falsely reassured by normal values. | ALT <33 W / <45 M · AST <32 W / <40 M | Are these tracking with my disease activity? Any flare? | [fill in] |
| Cause-specific markers | Hep B viral load + HBeAg, Hep C cured? (SVR12 negative), ferritin + iron studies (hemochromatosis), ANA + anti-SMA + anti-mitochondrial antibody (autoimmune), ceruloplasmin + 24h urine copper (Wilson), alpha-1 antitrypsin level. | Cause-specific | Are my cause-specific markers controlled? Treatment optimized? | [fill in] |
| FibroScan (transient elastography) | Non-invasive measure of liver stiffness/fibrosis. Replaces serial biopsy in many situations. Useful for monitoring response to cause-specific treatment (e.g., Hep C cure → liver stiffness improves). | kPa value: lower = less stiff (depends on cause) | When was my last FibroScan? How am I trending? | [fill in] |
| Med list with hepatic-dose review | Many drugs need hepatic dose adjustment. Review with the pharmacist at every change. Always tell every clinician (dentist, urgent care, ED) about cirrhosis before any prescription or contrast scan. NSAIDs absolute NO. Acetaminophen ≤2 g/day (less if drinker). | Hepatic dosing tables; check with pharmacist | Are all my doses correct? Any hepatotoxic drugs to avoid? | [fill in] |
➕Add-On Modules & Earnable Badges
Stackable modules that match your situation. Complete one to earn an extra badge on your certificate. Your institution can add their own.
⚖️ Daily Weight + Abdominal Girth Tracking
Same scale, same time of day; tape measure at the umbilicus weekly. Sudden weight gain >2 lb/day or 5 lb/week, increasing girth → ascites flare → call. Also catches subtle decompensation early.
🍷 Alcohol Cessation Plan
Connect with addiction medicine + AA/SMART Recovery + SAMHSA helpline (1-800-662-HELP). Naltrexone, acamprosate, baclofen, gabapentin can support cessation. Cessation is the only effective therapy for alcohol-associated cirrhosis.
💉 Vaccination Completion (Hep A, Hep B, flu, pneumo, COVID, RSV, Shingrix)
Viral hepatitis or other infections on top of cirrhosis are dangerous. Update vaccination passport; ask at every visit.
📋 HCC Surveillance Routine (Ultrasound q6mo + AFP)
Liver ultrasound every 6 months ± AFP. Standard surveillance in cirrhosis. Catches HCC early when treatable. Easy to skip — set a calendar reminder.
📋 Variceal Screening + NSBB Schedule
EGD at diagnosis; repeat by findings (1–3 years). NSBBs (propranolol, carvedilol, nadolol) for prevention if medium-large varices. Band ligation at endoscopy as needed.
💊 Lactulose + Rifaximin Routine for HE
Lactulose titrated to 2–3 soft stools/day. Rifaximin 550 mg BID for prevention of recurrent HE. Family HE-recognition drill so a dose is never missed when needed.
🩻 Paracentesis Preparation (Recurrent Ascites)
Pre-procedure labs (INR, platelets), albumin replacement during large-volume tap, post-tap monitoring, frequency planning, when to consider TIPS.
🔬 FibroScan Monitoring
Non-invasive vibration-controlled transient elastography for fibrosis tracking. Useful after Hep C cure or with MASH weight loss to confirm stabilization or regression.
💊 Hep C DAA Treatment Course
If Hep C is your cause: 8–12 weeks of direct-acting antivirals (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir). Adherence is everything. SVR12 negative = cure. Copay programs make this affordable.
🌱 Transplant Evaluation Pathway
The full list: labs, cardiac workup, dental clearance, financial review, social-work assessment, nutrition counseling, behavioral-health, surgical evaluation, listing, donor identification (deceased + living).
👨👩👧 Family HE-Recognition Drill
The loved one sees HE before the patient does (anosognosia). Drill the early signs (sleep changes, mild confusion, asterixis) and the not-driving-with-HE rule. Keep lactulose at home.
🧪 In a Cirrhosis Clinical Trial?
Protocol literacy, side-effect tracking, when to call the study coordinator vs your usual hepatology team. Trials currently enrolling in MASH (anti-fibrotics, GLP-1s, FGF21 analogs), HCC therapies, and transplant immunosuppression strategies.
📋 Advance Care Planning Workshop
POA, healthcare proxy, advance directive, POLST/MOLST, will, financial plan — done while capacity is clear. Important across the cirrhosis arc, especially before HE compromises decision-making capacity.
+ Add Your Institution's Module
Drop in your own — local hepatology center onboarding, transplant-center mentor program, addiction-medicine integration, anything.
🛡️Force Field Emergency Card
🛡️ Force Field Emergency Card FRIDGE · WALLET · EMT-READY
A one-page emergency record for any EMT, ER, new doctor, or transition visit. Print one for the fridge, one for your wallet. Updates anytime. This is the document you hand to a stranger when you can't speak for yourself.
🤝 My Care Team — call list for any clinician picking up my care
📘My Health Passport
📘 My Health Passport PATIENT-OWNED JOURNAL
This is your record — not your hospital's. Log every visit, capture every question for next time, and watch your own trends. Many of you get care at more than one hospital, on more than one record system. This Passport travels with you. Future versions will let you import data directly from your patient portals (the "Blue Button" vision).
🩺Working With a Prepared Patient
Your patient is going through a structured, evidence-based course. Here's how to get the most out of every visit, reduce ED use, prevent first-decompensation crises, support the caregiver, and partner well. Built on the AHRQ SHARE Approach, the IOM teach-back method, AASLD 2024 Practice Guidelines, EASL guidance, NIDDK and AGA recommendations, CDC Hepatitis B/C screening (universal), and SAMHSA evidence-based addiction medicine.
The SHARE Approach — your 5-step playbook
Use these steps in any order. Cycle back. Use teach-back at every transition. Source: AHRQ Pub. No. 25-0005 (Oct 2024).
💬Teach-Back & Risk Communication
The two highest-yield, lowest-cost SDM techniques. Use both at every visit.
🔁 Teach-Back (1–2 min)
- "Just so I know I explained it well — what would you tell your spouse about why we're starting carvedilol (NSBB for varices)? About the NSAID-absolute / acetaminophen-limited rules? About the four decompensation events to watch for?"
- Open-ended ("what" / "how"), not yes/no.
- If they get it wrong: "I must not have explained it well — let me try a different way." Then teach-back again.
- Use it for: NSAID-absolute / acetaminophen-limited rules + alcohol cessation + medication routine, when to call vs 911 (4 decompensation events), transplant evaluation pathway, advance care planning while capacity is clear.
- Document teach-back in your note — it's a quality measure and a billable element of care.
🔢 Communicating Numbers
- Use absolute risk, not relative. "13 out of 100" beats "13%" beats "1 in 8" beats "low risk."
- Keep denominators & timeframes constant when comparing options.
- Show, don't tell: icon arrays, Wong-Baker FACES, written summary.
- For lab numbers: give the action threshold, not just the value. "Your MELD-Na rose from 12 to 14 — at 15 we accelerate transplant evaluation. We're close to that threshold."
⚠️Cirrhosis-Specific Clinical Guardrails
Detection & Staging
- Screen at-risk adults: liver function tests + ultrasound + FibroScan in T2D + obesity (MASH risk), heavy alcohol use, prior or current Hep B / Hep C, family history of liver disease, hemochromatosis-prone families.
- Universal Hep C screening (CDC + USPSTF since 2020) — every adult once, more often if at risk.
- Hep B screening for at-risk groups; vaccinate the unvaccinated.
- Establish cause: viral serologies, autoimmune panel, ferritin/iron studies, ceruloplasmin, alpha-1 AT level, MASH workup (BMI, A1c, lipids, ultrasound, FibroScan, sometimes biopsy). Multiple causes often coexist.
- Stage: MELD-Na, Child-Pugh A/B/C, FibroScan kPa, imaging features.
- Refer to hepatology at diagnosis (or sooner — MELD-Na ≥10, decompensation event, HCC suspicion, complex cause).
Disease-Modifying Therapy (Cause-Specific)
- Hep C: DAAs (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) for 8–12 weeks. Cure (SVR12 negative) prevents progression. Universal screening + treatment is the public-health win.
- Hep B: long-term entecavir or tenofovir disoproxil/alafenamide for active disease per AASLD criteria.
- Autoimmune hepatitis: corticosteroids ± azathioprine; titrate.
- Hemochromatosis: therapeutic phlebotomy.
- Wilson disease: copper chelation (penicillamine, trientine) + zinc.
- Primary biliary cholangitis: ursodeoxycholic acid first-line; obeticholic acid second-line.
- MASH: weight loss 5–10% (foundation); GLP-1s (semaglutide, tirzepatide); resmetirom (FDA approved 2024 for MASH with fibrosis); statins safe and beneficial.
- Alcohol-associated: cessation is the only effective therapy. Naltrexone, acamprosate, baclofen, gabapentin support cessation. Refer to addiction medicine — not optional.
Decompensation Management & Surveillance
- Variceal screening: EGD at diagnosis; primary prophylaxis with NSBB (carvedilol preferred) or band ligation if medium-large varices.
- Ascites: sodium restriction (~2 g/day), diuretics (spironolactone + furosemide), large-volume paracentesis with albumin replacement when refractory; consider TIPS.
- HE: lactulose titrated to 2–3 soft stools/day; rifaximin for prevention of recurrent HE; identify triggers (GI bleed, infection, dehydration, sedating meds).
- SBP: high index of suspicion for fever or pain in patient with ascites; diagnostic paracentesis; IV ceftriaxone + albumin; long-term ciprofloxacin/norfloxacin prophylaxis after first episode.
- HCC surveillance: ultrasound q6mo + AFP in all cirrhosis.
- Bone density: baseline DXA; vitamin D + calcium repletion.
- Vaccinations: Hep A + Hep B (essential), influenza yearly, pneumococcal, COVID, RSV (60+), Shingrix, Tdap.
- Med safety: NSAIDs absolute NO (variceal bleeding + hepatorenal risk); acetaminophen ≤2 g/day (less if active drinker — usually ≤1 g/day); avoid sedating meds when HE-prone; statins are SAFE.
- Transplant evaluation: refer by MELD ~15 or first decompensation event. Pre-emptive evaluation improves outcomes.
🌍Cultural Competence & Trust
Cirrhosis carries deep stigma that delays care and worsens outcomes — and the stigma cuts in two directions. Alcohol-associated cirrhosis faces moral judgment that delays referral and (historically) blocked transplant access (the 6-month sobriety rule has been substantially relaxed in many programs). MASH cirrhosis faces "you should have lost weight" judgment. Both deserve compassion. Transplant access disparity exists for AA / Hispanic patients (lower referral rates, longer waits, fewer living donors). Hep C universal screening (CDC + USPSTF since 2020) is meant to close screening gaps in underserved communities. Repair starts in your office.
- Use universal Hep C screening as the standard — every adult once, more often if at risk. Don't wait for the patient to "look at risk."
- Refer early to addiction medicine for alcohol-associated cirrhosis — without judgment, without preconditions. The 6-month sobriety rule for transplant has been relaxed in many programs based on evidence.
- Refer to transplant evaluation by MELD ~15 or first decompensation, regardless of cause. Cause-specific transplant policies should be evidence-based, not stigma-driven.
- Use qualified medical interpreters — never family, never minor children except in true emergencies. Transplant-evaluation, alcohol-cessation, and HE conversations must be done in the patient's primary language.
- Invite the caregiver in. With patient consent — decisions about transplant evaluation, alcohol cessation support, and HE recognition are family decisions in many cultures.
- Name the bias. "I know cirrhosis sometimes carries stigma — both for alcohol-associated and MASH cirrhosis. We try not to let that affect care here. Tell me if anything feels off."
🏥Customize for Your Institution
Clone this course and replace the highlighted blocks with your own information. Each editable field below is a placeholder — change it once and it propagates through the patient view.
📞 What Should Replace the When-to-Call Block
- 24/7 hepatology on-call number
- Hepatology center outpatient hours & address
- Specialty pharmacy line (DAAs / antivirals / NSBBs / lactulose-rifaximin)
- GI / endoscopy line (variceal screening + paracentesis)
- Transplant center referral & coordinator contact
- Addiction medicine direct line + SAMHSA 1-800-662-HELP
- American Liver Foundation local resources / chapter contact
- Patient portal login URL with caregiver proxy
👤 Who Is Your Hepatology Care Navigator?
- Name, role, photo, calendly/booking link.
- What teach-back / device check-ins they own (daily weight + abdominal girth, NSAID-absolute / acetaminophen-limited rules, alcohol-cessation tracking, HE recognition drill, vaccination passport).
- How patients and care partners reach them between visits.
- How they handle prior-auth navigation (DAAs, GLP-1s, resmetirom), copay help, and transplant-evaluation triage.
📚 Add Your Own Modules
- Your clinical trial protocols (MASH anti-fibrotics, FGF21 analogs, GLP-1 trials, transplant immunosuppression).
- Hepatology dietitian onboarding letter — adequate protein matters; sodium balance for ascites; weight management for MASH.
- Insurance & financial-aid pathways (especially Hep C DAA copay assistance, ALF financial-aid, foundation grants).
- Local peer support partners (ALF chapter, transplant recipient + living-donor mentor pairs, AA / SMART Recovery / addiction-medicine community partners).
🎨 Re-skin in 2 Lines of CSS
--inst-primary: your brand color- Replace the FFH × American Liver Foundation × [Your Institution] cobrand in the hero
- Drop in your logo PNG (white version) — same 48px height as FFH logo
📚 Evidence Base — what this course is built on
- AHRQ SHARE Approach — 5-step shared decision making framework. AHRQ Pub. 25-0005, Oct 2024. ahrq.gov/sdm
- AHRQ Health Literacy Universal Precautions Toolkit (3rd ed.) — teach-back, plain language, accessible materials. AHRQ Pub. 23-0075, March 2024.
- American Liver Foundation — Patient + Family Resources — epidemiology, equity, peer-mentor program, ALF helpline, financial assistance.
- AASLD 2024 Practice Guidelines — comprehensive guidance on cirrhosis evaluation, decompensation management, HCC surveillance, transplant referral, cause-specific therapy.
- EASL Clinical Practice Guidelines — European guidance on cirrhosis, MASH, viral hepatitis, autoimmune liver disease.
- NIDDK — Liver Disease Information Clearinghouse — comprehensive patient and clinician summaries.
- AGA Clinical Practice Guidelines — gastroenterology guidance on variceal screening, ascites, HE, and related topics.
- CDC + USPSTF Universal Hep C Screening (2020) — every adult at least once; close the underdiagnosis gap.
- SAMHSA evidence-based addiction medicine — for alcohol-associated liver disease; helpline 1-800-662-HELP. Naltrexone, acamprosate, baclofen, gabapentin as MAT options.
- FDA approval of resmetirom (Rezdiffra) for MASH with significant fibrosis (2024) — first FDA-approved drug specifically for MASH; landmark in the MASH treatment landscape.
- Direct-Acting Antiviral (DAA) trials for Hep C cure — sofosbuvir/velpatasvir, glecaprevir/pibrentasvir; SVR12 negative = cure; one of the great modern wins in cirrhosis prevention.
- AHRQ PEMAT — Patient Education Materials Assessment Tool. Used to grade understandability & actionability.
- Stanford Chronic Disease Self-Management Program (CDSMP) — peer-led, self-efficacy backbone of the Tier 3 advocacy work.
- FFH Prepared Patient · Hypertension course & · Type 2 Diabetes course — the upstream cluster courses whose unified Module 7 (canonical, MD5 7587a559b24ca8b9bab40b1756475d84) is CROSS-REFERENCED from this Cirrhosis course's Module 7 (T2D-driven MASH is the metabolic-hepatic arc), NOT embedded or modified.
- FFH Prepared Patient · CKD course — sister sprint-5 course; together CKD + Cirrhosis form the renal + hepatic outcome arcs of the unified cluster.
Course content is educational and not a substitute for medical advice from your own clinicians. Institutions cloning this course are responsible for accuracy of all customized blocks.