Medical Record Documentation of Goals-of-Care Discussions Among Older Veterans With Incident Kidney Failure

Abstract

Rationale & Objective: Elicitation and documentation of patient preferences is at the core of shared decision making and is particularly important among patients with high anticipated

Cardiopulmonary Resuscitation Preferences of People Receiving Dialysis

“…We suspect that framing discussions about future care around patients’ values and goals rather than their preferences for specific interventions like CPR may be helpful in improving the quality of end-of-life care. 23 , 46 , 47 , 48 …”

“…We suspect that framing discussions about future care around patients' values and goals rather than their preferences for specific interventions like CPR may be helpful in improving the quality of end-of-life care. 23,[46][47][48] Prior studies conducted in patients with kidney disease and in other populations support the feasibility and effectiveness of engaging patients and families in advance care planning. 42,[49][50][51][52][53][54][55][56][57][58] That a substantial proportion of participants herein who did not want to be resuscitated had documented neither a surrogate decision maker nor treatment preferences illuminates an important gap in care.…”

“…20 Because resuscitation preferences are often elicited reflexively at times of transition, such as hospital admission or dialysis initiation or when obtaining consent for procedures, these conversations may not be integrated with a broader process of advance care planning that explores patients' values, goals, expectations, and preferences for future care. 22,23 Although at least 1 study 3 has attempted to gauge the extent to which the resuscitation preferences of patients undergoing dialysis are honored, no prior studies to our knowledge have evaluated the association between patients' resuscitation preferences and how they respond to questions about other aspects of end-of-life care. This study used data collected from patients receiving dialysis who participated in a survey about end-of-life care to describe the association of resuscitation preferences with selfreported participant characteristics and with other domains of palliative and end-of-life care.…”

Video Images about Decisions for Ethical Outcomes in Kidney Disease (VIDEO-KD): the study protocol for a multi-centre randomised controlled trial

“…These include organisations that represent the Mid-Atlantic (Hospital of the University of Pennsylvania), Northeast (Boston Medical Center, Massachusetts General Hospital, Brigham and Women’s Hospital, Renal Transplant Associates of New England), Southwest (University of New Mexico), West (Stanford University, Veterans Affairs Palo Alto Health Care System), Northwest (University of Washington) and Midwest (University of Pittsburgh Medical Center) regions. These systems represent a geographically diverse sample of patients and feature researchers and clinicians with expertise in the care of older patients with advanced CKD 38 61–67. Combined, these centres have over 80 000 outpatient nephrology visits annually.…”

Assessing Quality in Advance Care Planning Documentation: A Survey of Current Methods

“…Three randomized controlled trials (RCTs), 5,6,13,14 2 prospective cohort studies, 5,15 4 retrospective cohort studies, [16][17][18][19] and 2 cross sectional studies were included 20,21 (Table 1). Studies included a range of patient populations, including patients with advanced kidney disease, 16,17 inpatients with hematologic malignancy, 21 high-risk primary care patients, 5,20 and oncology outpatients. 14 Sample sizes ranged from 50 to 2493 subjects.…”