Advance care planning in chronic kidney disease: A national Danish survey of knowledge and attitudes among clinicians

Abstract

IntroductionPatients with chronic kidney disease and their families strongly request advance care planning. They want it to start early—before treatment decisions are made—and to be an ongoing process during their illness trajectory. Previous international studies show that health care professionals find there to be significant barriers that impact the extent of involvement in advance care planning.AimTo identify Danish nephrology health care professionals' knowledge and attitudes to advance care planning and the status of current advance care planning practice in Denmark.MethodAn anonymous, cross‐sectional survey was administrated online. The questionnaire was developed in Australia and translated and culturally adapted into Danish. Health care professionals were recruited via email lists. In descriptive statistics and multiple ordinal regression, the influence of the respondents' attributes on the extent of involvement in advance care planning was explored, along with the involvement of family, and skills, comfort, barriers and facilitators in relation to advance care planning.ResultsThe 207 respondents comprised nephrologists (23%), other physicians (8%), nurses (62%) and other HCPs (7%), of whom 27% had participated in advance care planning training. In total, 66% indicated that they lacked access to material about advance care planning for patients with chronic kidney disease and 46% indicated that the conversations were performed ad hoc. A total of 47% reported that advance care planning was performed well at their workplace. Reported barriers were time, lack of experience and procedure. Training in advance care planning could facilitate the involvement. Nurses were less likely to feel skilled and comfortable in engaging advance care planning, while those with more than 10 years of experience were more likely to feel skilled and comfortable.ConclusionTraining in advance care planning with patients with chronic kidney disease and their families on both a theoretical and clinical level is important to ensure comfort among health care professionals and to facilitate the extent of involvement. A systematic chronic kidney disease‐specific approach is significant, in order to guide the conversations and ensure that advance care planning is conducted to a set standard.

Decisional needs in people with kidney failure, their relatives and health professionals about end‐of‐life care options: A qualitative interview study

“…Knowledge in this field in a Danish context is very sparse, and no relevant Danish studies were identified in our literature search. Since then, however, a new Danish cross-sectional study has been published (Frandsen et al, 2023), which describes an investigation of HPs' knowledge and attitudes regarding the use of ACP in patients with chronic kidney disease. The study found that 66% of participating HPs lacked access to material on how ACP can be used and that 46% conducted EoL conversations sporadically.…”

Shared decision making in elderly patients with kidney failure

“…Another RCT also showed that monthly palliative care visits in addition to usual nephrology care led to improvement in overall and physical symptoms as well as increased adoption of ACP directives [ 113 ]. However, there are barriers to ACP in CKD patients and their families, including timing issues, concerns about patient and family ailments, limited resources and expertise, difficulties in predicting outcomes, and a lack of shared understanding within nephrology departments regarding the integration of ACP [ 114 ].…”

Advance care planning to patients with chronic kidney disease and their families: An intervention development study

“…Healthcare professionals experience barriers to the initiation of the ACP conversation with patients and their families. These barriers include: fear of upsetting patients and relatives, and lack of time, resources or expertise (Frandsen et al, 2023;Luckett et al, 2017;O'Hare et al, 2016;Sellars et al, 2017) Furthermore, they request a more systematic approach to the ACP conversation, to ensure a shared understanding and vision, and in order to integrate ACP into clinical practice and care for patients and families (Frandsen et al, 2023;Luckett et al, 2017;O'Hare et al, 2016;Sellars et al, 2017).…”