Failure of advance care planning to elicit patients' preferences for withdrawal from dialysis

Holley, Jean Lake; Hines, Stephen C.; Glover, Jacqueline J.; Babrow, Austin S.; Badzek, Laurie; Moss, Alvin H.

doi:10.1016/s0272-6386(99)70220-9

Cited by 91 publications

(53 citation statements)

References 10 publications

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“…The growing literature surrounding end-of-life care in renal patients has been largely centered around advanced care planning for patients who are established on dialysis and symptom control in palliative care of patients who have withdrawn from dialysis (19,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). The next step in improving care for patients with kidney failure is to discuss initiation of dialysis (versus MCM) earlier.…”

Section: Discussionmentioning

confidence: 99%

Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?

Carson

Juszczak

Davenport

et al. 2009

Clinical Journal of the American Society of Nephrology

397

388

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Background and objectives: There is ongoing growth of elderly populations with ESRD in Western Europe and North America. In our center, we offer an alternative care pathway of 'maximum conservative management' (MCM) to patients who elect not to start dialysis, often because of a heavy burden of comorbid illness and advanced age. The objective of our study was to compare clinical outcomes for patients who had ESRD and chose either MCM or renal replacement therapy (RRT).Design, setting, participants, & measurements: This is an observational study of a single-center cohort in the United Kingdom that evaluating 202 elderly (>70 yr) patients who had ESRD and had chosen either MCM (n ‫؍‬ 29) or RRT (n ‫؍‬ 173). We report survival, hospitalization rates, and location of death for this cohort. Survival was measured from a standardized 'threshold' estimated GFR of 10.

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Section: Discussionmentioning

confidence: 99%

Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?

Carson

Juszczak

Davenport

et al. 2009

Clinical Journal of the American Society of Nephrology

397

388

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“…In the same survey, 85% responded that it was "extremely important or at least somewhat important to be informed about the option to withdraw" (9). Historically, however, patients do not discuss this option with their families (13) and, further, are likely to expect health care providers to raise this issue if and when appropriate (14). The shared decision-making process of communication has been heralded as the pinnacle of patient care and is recommended for decisions of the magnitude of continuing or stopping dialysis (2,15).…”

Section: Preparedness Planning: the Role For Advance Care Planningmentioning

confidence: 99%

Dying on Dialysis

Schmidt

Moss

2014

Clinical Journal of the American Society of Nephrology

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SummaryAcceleration of comorbid illness in patients undergoing long-term maintenance hemodialysis may be manifested by clinical deterioration that is subtle and not immediately life-threatening. Nonetheless, it is emotionally debilitating for patients and families in addition to being medically and ethically challenging for treating nephrologists. A marked decline in clinical status warrants review of the balance of benefits to burdens dialysis is providing to a given patient and should trigger conversation about the option of withdrawal using an individualized patient-centered, rather than disease-oriented, approach. This paper presents a rationale for and an objective approach to initiating and managing dialysis withdrawal for patients who wish to withdraw because of unsatisfactory quality of life and those (many with significant cognitive impairment) for whom withdrawal is deemed appropriate because the burdens of continuing treatment substantially outweigh the benefits.

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“…For example, while patients with ESRD prefer to be given information about their prognosis by their physicians and those who participate in end-of-life discussions tend to prefer less aggressive care, few dialysis patients report having had even limited discussions about their wishes (28,(32)(33)(34). The dearth of discussions is likely fueled by provider uncertainty about prognosis and a lack of attention during training (35)(36)(37).…”

Section: Barriers To a Palliative Approach To Dialysis Provider Barriersmentioning

confidence: 99%

A Palliative Approach to Dialysis Care

Grubbs

Moss

Cohen

et al. 2014

Clinical Journal of the American Society of Nephrology

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131

116

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As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of <1 year may desire a palliative approach to dialysis care, which focuses on aligning patient treatment with patients' informed preferences. This commentary elucidates what comprises a palliative approach to dialysis care and describes its potential and appropriate use. It also reviews the barriers to integrating such an approach into the current clinical paradigm of care and existing infrastructure and outlines system-level changes needed to accommodate such an approach.

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Failure of advance care planning to elicit patients' preferences for withdrawal from dialysis

Cited by 91 publications

References 10 publications

Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?

Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?

Dying on Dialysis

A Palliative Approach to Dialysis Care

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