根据巴塞罗那临床肝癌分期系统，对于肝移植不合格的终末期肝细胞癌患者，姑息治疗的延迟和限制可能是由于在缺乏共同指南的情况下肝病学家和姑息治疗医生之间的不同看法造成的。评估医生的态度致力于终末期肝细胞癌的姑息治疗，了解更有效的治疗存在哪些障碍，并由姑息治疗医生和肝病专家共同分享。意大利肝病研究协会和意大利姑息治疗协会的成员是受邀参加一项基于网络的调查，旨在调查不适合肝移植的终末期肝细胞癌患者的实际管理态度。两个协会的医生成员，代表国内多家医院和服务机构。97 名肝病专家和 70 名姑息治疗专家完成调查的护理医生：>80% 定期随访 1-19 名患者； 58% 的肝病专家与姑息治疗医生合作管理患者，55% 的姑息治疗医生在没有肝病专家帮助的情况下照顾患者。两组之间的肝硬化治疗在白蛋白处方、食管胃十二指肠镜检查、抗病毒治疗、抗凝、腹腔穿刺术指征和脑病治疗方面存在显着差异。全剂量对乙酰氨基酚在肝病专家中广泛使用，而阿片类药物则两种类型均常用，无论肝功能如何，均以全剂量使用。这项调查强调了对不适合肝移植的终末期肝细胞癌患者的治疗方法存在显着差异，强化了需要就该环境中的姑息治疗制定共同指南和进一步研究。

Delays and limitations of palliative care in patients with liver transplantation-ineligible end-stage hepatocellular carcinoma according to Barcelona Clinic Liver Cancer staging system may be explained by different perceptions between hepatologists and palliative care physicians in the absence of shared guidelines.To assess physicians' attitudes toward palliative care in end-stage hepatocellular carcinoma and to understand what the obstacles are to more effective management and co-shared between palliative care physicians and hepatologists.Members of the Italian Association for the Study of Liver Disease and the Italian Society of Palliative Care were invited to a web-based survey to investigate practical management attitude for patients with liver transplant-ineligible end-stage hepatocellular carcinoma.Physician members of the of the two associations, representing several hospitals and services in the country.Ninety-seven hepatologists and 70 palliative care physicians completed the survey: >80% regularly follow 1-19 patients; 58% of hepatologists collaborate with palliative care physicians in the management of patients, 55% of palliative care physicians take care of patients without the aid of hepatologists. Management of cirrhosis differed significantly between the two groups in terms of prescription of albumin, esophagogastroduodenoscopy, anti-viral treatment, anticoagulation, indication to paracentesis and management of encephalopathy. Full-dose acetaminophen is widely used among hepatologists, while opioids are commonly used by both categories, at full dosage, regardless of liver function.This survey highlights significant differences in the approach to patients with liver transplantation-ineligible end-stage hepatocellular carcinoma, reinforcing the need for shared guidelines and further studies on palliative care in the setting.