Advance Care Planning for Patients with Advanced CKD

Holley, Jean Lake

doi:10.2215/cjn.00290115

Cited by 25 publications

(16 citation statements)

References 22 publications

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“…They kind of keep pushing forth. 5 Dialysis nurse With this kind of a chronic disease process and things that might happen, it's a good thing to . .…”

Section: Discussionmentioning

confidence: 99%

“…They are so overwhelmed by the notion that they are going to need to start dialysis. 5 Dialysis nurse (responding to a question about when ACP should be conducted)…”

Section: Theme 3: Unclear Locus Of Responsibility and Authority For Acpmentioning

confidence: 99%

“…Palliative care nurse I think that one problem that I've had is that sometimes I just want the social worker; I can't do an advance directive with a patient, because I'm a nurse and only the social worker can do that. 5 Social worker Technically, the doctors are not supposed to be involved in advance care directives . .…”

Section: Theme 3: Unclear Locus Of Responsibility and Authority For Acpmentioning

confidence: 99%

“…There is growing interest in efforts to enhance ACP for patients with advanced kidney disease (3)(4)(5)(6). In this population, low rates of completion of advance directives (7) and low levels of prognostic awareness (8) coexist with intensive patterns of endof-life care focused on life prolongation (9,10).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

O’Hare

Szarka

McFarland

et al. 2016

CJASN

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Background and objectives There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease.Design, setting, participants, & measurements Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory.Results The comments of providers interviewed for this study spoke to significant system-level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients. ConclusionsThe comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease.

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“…They kind of keep pushing forth. 5 Dialysis nurse With this kind of a chronic disease process and things that might happen, it's a good thing to . .…”

Section: Discussionmentioning

confidence: 99%

“…They are so overwhelmed by the notion that they are going to need to start dialysis. 5 Dialysis nurse (responding to a question about when ACP should be conducted)…”

Section: Theme 3: Unclear Locus Of Responsibility and Authority For Acpmentioning

confidence: 99%

Section: Theme 3: Unclear Locus Of Responsibility and Authority For Acpmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

O’Hare

Szarka

McFarland

et al. 2016

CJASN

View full text Add to dashboard Cite

show abstract

“…Establishing good relationships with the patients and investing in them through carefully listening to their needs and wishes are crucial tools for moving toward this new approach to care (9). Health care systems have also come to focus on the provision of effective evidence-based care building on the patients' expectations (10). The American Society of Nephrology also emphasizes the importance of increasing patient participation and understanding the patients' preferences and goals for improving the process of medical decision-making (11).…”

Section: Introductionmentioning

confidence: 99%