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My mother also had Stage 4 with a lot of big liver mets, but she didn't have as many as your father. She had times when her thinking was not clear, but she never tried lactulose. She would get a little confused when her pain was bad and she was on high doses of pain meds, but mostly it made her sleepy. When she got an infection, when she wasn't on chemo anymore, this also made her confused. It was very very hard. Sometimes it helped to put on some music that she liked, and show her pictures of the family, or even just read to her. Sometimes, she found those things comforting and familiar.
Thinking of you and your Dad, and hoping for better days.
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