Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis

Nesrallah, Gihad; Dixon, Stephanie N.; MacKinnon, Marnie; Jassal, Sarbjit V.; Bota, Sarah E.; Dirk, Jade; Arthurs, Erin; Blake, Peter G.; Sood, Manish M.; Garg, Amit X.

doi:10.1177/2054358118783761

Cited by 13 publications

(13 citation statements)

References 14 publications

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“…Many people treated with PD face a high burden of comorbidity, short life expectancy, low quality of life, socioeconomic deprivation, and high rates of anxiety and depression. 24 Therefore, for shared decision making to be effective, engagement, education, and empowerment of these individuals are all crucial. All these goals can be achieved with person-centered care.…”

Section: Commentarymentioning

confidence: 99%

KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis

Teitelbaum¹,

Glickman

Neu

et al. 2021

American Journal of Kidney Diseases

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Section: Commentarymentioning

confidence: 99%

KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis

Teitelbaum¹,

Glickman

Neu

et al. 2021

American Journal of Kidney Diseases

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“…It can reduce the number of emergency room visits [8], admissions to intensive care units [8], hospitalizations [9], hospital deaths, and health care costs [10]. It can also increase the length of the home stays of patients [11] and the rate of home deaths [8, 12, 13]. Those patients who received home-based palliative care and their families also felt safe and hopeful [14].…”

Section: Introductionmentioning

confidence: 99%

An examination of home-based end-of-life care for cancer patients: a qualitative study

Lai

Chen

et al. 2019

BMC Palliat Care

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BackgroundOnly a small number of patients have utilized the home-based end-of-life care service in Shanghai that has been offered since 2012. This study explores how home-based end-of-life care is delivered in community health service centers in Shanghai and examines the difficulties in the delivery of the care.MethodsThis was a qualitative study in which data were collected from interviews and analyzed using qualitative content analysis. Nineteen health care providers with experience in delivering home-based end-of-life care in 12 community health service centers were recruited. The interviews were conducted between August 2018 and February 2019.ResultsFour themes emerged from the interviews: (i) Patients under home-based end-of-life care: Patients receiving the care were cancer patients with less than 1 year of life expectancy. The criteria for patients were broad. (ii) Service structure: The service was delivered regularly by the physicians and nurses using the approaches of home visits and/or telephone follow-ups. (iii) Service process: The service consisted of multiple components, including monitoring the patient’s condition, managing the patient’s symptoms, giving daily care instructions, performing nursing procedures, and giving psychological support. However, most of the care focused on monitoring the patients and managing their physical discomfort. (iv) Difficulties in delivering care: Being unable to provide the service and feeling powerless when facing psycho-spiritual problems were the two major difficulties. Three factors contributed to the suspension of the service: The gap between the service and the needs of the patients, a lack of patients, and low work motivation. The demand that the truth be concealed from the families and their attitude of avoiding talking about death were the key factors of the failure of psycho-spiritual care.ConclusionsSeveral issues should be addressed before the service can be further developed, including fully understanding the needs and preferences of local patients and their families, securing more financial support and a better supply of drugs, delivering better training for staff, and ensuring greater rewards for individuals and institutions providing the service.

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“…4 A recent study of dialysis patient’s end of life (EOL) in Ontario demonstrated one-third died in intensive care unit, another one-third died in an acute care hospital or emergency department while few received palliative care. 5 These findings suggest EOL on dialysis may be suboptimal and not consistent with patient wishes.…”

Section: Introductionmentioning

confidence: 96%

Facility Variation and Predictors of Do Not Resuscitate Orders of Hemodialysis Patients in Canada: DOPPS

Moorman

Mallick

Rhodes

et al. 2019

Can J Kidney Health Dis

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Background: Life expectancy in patients with end-stage kidney disease treated with hemodialysis (HD) is limited, and as such, the presence of an advanced care directive (ACD) may improve the quality of death as experienced for patients and families. Strategies to discuss and implement ACDs are limited with little being known about the status of Do Not Resuscitate (DNR) orders in the Canadian HD population. Objectives: Using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), we set out to (1) examine the variability in DNR orders across Canada and its largest province, Ontario and (2) identify clinical and functional status measures associated with a DNR order. Design: We conducted a retrospective cohort study using data from the DOPPS Canada Phase 4 to 6 from 2009 to 2017. Setting: DOPPS facilities in Canada. Patients: All adults (>18 years) who initiated chronic HD with a documented ACD were included. Measurements: ACD and DNR orders. Methods: Descriptive statistics were compared for baseline characteristics (demographics, comorbidities, medications, facility characteristics, and patient functional status) and DNR status. The crude proportion of patients per facility with a DNR order was calculated across Canada and Ontario. Functional status was determined by activities of daily living and components of the Kidney Disease Quality of Life (KDQOL)-validated questionnaire. We used generalized estimating equations (GEEs) to create sequential multivariable models (demographics, comorbidities, and functional status) of variables associated with DNR status. Results: A total of 1556 (96% of total) patients treated with HD had a documented ACD and were included. A total of 10% of patients had a DNR order. The crude variation of DNR status differed considerably across facilities within Canada, between Ontario and non-Ontario, and within Ontario (interprovince variation = 6.3%-17.1%, Ontario vs non-Ontario = 8.2% vs 11.7%, intraprovincial variation [Ontario] = 1%-26%). Patients with a DNR order were more commonly older, white, with cardiac comorbidities, with less or shorter predialysis care compared with those without a DNR order. Patients with a DNR order reported lower energy, more difficulty with transfers, meal preparation, household tasks, and financial management. In a multivariate model, age, cardiac disease, stroke, dialysis duration, and intradialytic weight gain were associated with DNR status. Limitations: Relatively small number of events or measures in certain categories. Conclusions: A large inter- and intraprovincial (Ontario) variation was observed regarding DNR orders across Canada highlighting areas for potential quality improvement. While functional status did not appear to have a bearing on the presence of a DNR order, the presence of various comorbidities was associated with the presence of a DNR order.

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Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis

Cited by 13 publications

References 14 publications

KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis

KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis

An examination of home-based end-of-life care for cancer patients: a qualitative study

Facility Variation and Predictors of Do Not Resuscitate Orders of Hemodialysis Patients in Canada: DOPPS

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