Insight Into Advance Care Planning for Patients on Dialysis

Abstract

Context. Advance care planning is not included in regular clinical care for patients on dialysis. Insight into life-sustaining treatment preferences and communication about end-of-life care is necessary to develop interventions to improve advance care planning for patients on dialysis. Objectives. This cross-sectional observational study aimed to understand the preferences for life-sustaining treatments of outpatients on dialysis and to study the quality of patient-physician communication about end-of-life care and barriers and facilitators to this communication. Methods. The following outcomes were assessed in 80 clinically stable dialysis patients: demographics, clinical characteristics, life-sustaining treatment preferences (cardiopulmonary resuscitation and mechanical ventilation, and Willingness to Accept Life-Sustaining Treatment instrument), preference for site of death, quality of communication (Quality of Communication Questionnaire), and barriers and facilitators to communication about end-of-life care (Barriers and Facilitators Questionnaire). Results. Patients were able to indicate their preferences for life-sustaining treatments and site of death. Preferences for life-sustaining treatments depend on the specific treatment, the expected outcome of treatment, and likelihood of an adverse outcome. Life-sustaining preferences were discussed with the nephrologist by 30.3% of the patients. Quality of the patient-physician communication about end-of-life care was rated poor. This study identified several barriers and facilitators to end-of-life care communication. Conclusion. Patients should receive information about treatment burden, expected outcome, and the likelihood of an adverse outcome when discussing

Within-Day Test-Retest Reliability of the Timed Up & Go Test in Patients With Advanced Chronic Organ Failure

“…[20][21][22][23][24][25][26][27][28][29][30] For the present study, only the results from the baseline assessment were considered. The study received approval from the Medical Ethical Committee of the Maastricht University Medical Center þ (MUMCþ), Maastricht, the Netherlands (MEC 07-3-054), and all patients gave written informed consent.…”

“…From the 265 subjects initially included in the main study, [20][21][22][23][24][25][26][27][28][29][30] 30 were excluded from the current analysis because they were not able to perform 3 TUG trials. Table 1 presents the general characteristics of the 235 elderly subjects included.…”

Dying on Dialysis

“…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). Unfortunately, two recent studies show that nephrologist communication with patients is poor and that nephrologists rarely discuss with them prognosis and other information needed for shared decision-making with regard to end-of-life treatment (16,17).…”

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

“…Because many of these patients have other serious health conditions and may be cared for by a range providers in a variety of settings during the course of illness (25), these earlier studies may have failed to capture and address the complexity of care for this patient population. We undertook a qualitative study to gain insight from providers from a range of disciplines and specialties who care for patients with advanced kidney disease to identify potential opportunities to enhance ACP for this population.…”