Ethical Challenges and the Role of Palliative Care in Kidney Disease

Germain, Michael J.; Cohen, Lewis M.

doi:10.1016/b978-0-323-52978-5.00020-3

Cited by 1 publication

(1 citation statement)

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“…The doctor-patient relationship needs to change towards an interpretative one, respecting the principle of consideration of patient preferences and values. Those are the steps needed to allow shared decision-making 32 . This process also necessitates a well-conceived education program, offering to the patient and his/ her family information on all available therapeutic options with their pros and cons, in order to enable a well-informed choice of treatment, and care should be taken that the patient receives this choice, unless clinically contraindicated.…”

Section: At Presentmentioning

confidence: 99%

Planning ESKD treatment: a plea for a stepwise person-centered approach including conservative care

Sá¹,

Vanholder²

2019

pjnh

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A paradigm shift in the treatment of end-stage kidney disease (ESKD) is urgently needed. New ESKD policies should include integrated and person-centered care that focuses on the individual's preferences, needs, and values for health care. Based on the example of Portugal, a country with a very high number of prevalent in-center hemodialysis patients, the authors reflect on the past and present of ESKD treatment worldwide, trying to summarize the conceptual changes in the efficiency and equity of ESKD treatment. An optimal approach in ESKD management should consider all options for renal replacement therapy, including a comprehensive conservative approach, of which the incidence and prevalence should be reported on a regular basis for each country and for Europe. An active holistic care to patients with ESKD suffering from severe illness or near the end of life, without dialysis or kidney transplant, is still frequently ignored as an option. In cases of frail or very old individuals or in those with multiple co-morbidities or in poor physical condition, conservative treatment should be considered as a firstline option. A proposal of ESKD treatment following the model of classification of CKD is presented. Up-to-date regulations from national health authorities are needed, especially on the priority policy of supportive/palliative care in non-malignant disease, including ESKD.

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Section: At Presentmentioning

confidence: 99%