The need for end-of-life care training in nephrology: national survey results of nephrology fellows

Holley, Jean Lake; Carmody, Sharon S.; Moss, Alvin H.; Sullivan, Amy; Cohen, Lewis M.; Block, Susan D.; Arnold, Robert M.

doi:10.1016/s0272-6386(03)00868-0

Cited by 158 publications

(109 citation statements)

References 10 publications

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“…This suggests that clinical experience rather than education during training prepares nephrologists to deal with the complex end-of-life decision-making that is required when caring for patients with ESRD. This is not surprising given that end-of-life care is not well addressed in renal fellowship training (12). Second-year fellows report feeling unprepared to care for their dying patients (12).…”

Section: Discussionmentioning

confidence: 99%

Nephrologists’ Reported Preparedness for End-of-Life Decision-Making

Davison

Jhangri

Holley

et al. 2006

Clinical Journal of the American Society of Nephrology

139

114

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Nephrologists commonly engage in end-of-life decision-making with patients with ESRD and their families. The purpose of this study was to determine the perceived preparedness of nephrologists to make end-of-life decisions and to determine factors that are associated with the highest level of perceived preparedness. The nephrologist members of the Renal Physicians Association (RPA) and the Canadian Society of Nephrology were invited to participate in an online survey of their end-of-life decision-making practices. A total of 39% of 360 respondents perceived themselves as very well prepared to make end-of-life decisions. Age >46 yr, six or more patients withdrawn from dialysis in the preceding year, and awareness of the RPA/ American Society of Nephrology (ASN) guideline on dialysis decision-making were independently associated with the highest level of self-reported preparedness. Nephrologists who reported being very well prepared were more likely to use time-limited trials of dialysis and stop dialysis of a patient with permanent and severe dementia. Compared with Americans, Canadian nephrologists reported being equally prepared to make end-of-life decisions, stopped dialysis of a higher number of patients, referred fewer to hospice, and were more likely to stop dialysis of a patient with severe dementia. Nephrologists who have been in practice longer and are knowledgeable of the RPA/ASN guideline report greater preparedness to make end-of-life decisions and report doing so more often in accordance with guideline recommendations. To improve nephrologists' comfort with end-of-life decision-making, fellowship programs should teach the recommendations in the RPA/ASN guideline and position statement.

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Section: Discussionmentioning

confidence: 99%

Nephrologists’ Reported Preparedness for End-of-Life Decision-Making

Davison

Jhangri

Holley

et al. 2006

Clinical Journal of the American Society of Nephrology

139

114

View full text Add to dashboard Cite

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“…Younger nephrologists tend to express less self-assessed preparedness for discussions around end-of-life issues than those with longer experience (67). In addition, in a survey of nephrology fellows, although 99% identified that it was important to provide end-of-life care, they believed that they received the least education and felt least prepared to provide this type of care (68). As a result, renal training programs are encouraged to incorporate into their training programs formal training for end-of-life care and communication skills.…”

Section: Nonaggressive Renal Care and End-of-life Carementioning

confidence: 98%

Dialysis in Late Life

Jassal¹,

Watson²

2009

Clinical Journal of the American Society of Nephrology

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As a result of the changing dialysis demographics, nephrologists are increasingly faced with problems traditionally considered to be geriatric issues. The specialty of nephrology has often been seen as using intensive, expensive, and complex technologies for patient care. Dialysis programs have evolved into highly efficient, fast-paced units that accommodate a rapid turnover of patients. They are in direct contrast to geriatric programs, which use geriatric principles to offer simple, multidimensional, holistic care to frail older patients. Finding the balance between nephrology and geriatric skill sets is a particular challenge for up-and-coming nephrologists who have an interest in geriatric nephrology. This mini-review addresses some of the challenges, increases awareness of specific issues, and highlights new opportunities in this field.

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“…8 Additional survey questions were developed from a similar study used to assess medical student, resident, and faculty palliative care training. 3,9 Thereafter all questions were pilot-tested for face and content validity with oncology fellows and attending oncologists at West Virginia University.…”

Section: Surveymentioning

confidence: 99%

Palliative Care Training during Fellowship: A National Survey of U.S. Hematology and Oncology Fellows

Thomas

Curley

Wen

et al. 2015

Journal of Palliative Medicine

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Background: Despite requirements for palliative care training during fellowship, there is a paucity of recent data regarding the attitudes, knowledge, and skills of hematology/ oncology fellows in palliative care. Objective: Our aim was to assess fellows' attitudes toward and quality of training in palliative care during fellowship and perceived preparedness to care for patients at the end of life (EOL). Methods: In May 2013 a cross-sectional survey of hematology/oncology fellows was conducted. Results: Fellows from 93 of 138 fellowship programs responded (67.4%). Of the 347 fellows e-mailed, 176 participated. Nearly all fellows (99%) indicated that physicians have a responsibility to help patients at EOL. Fellows felt their overall training in fellowship was superior to training in EOL care (4.24 -0.78 versus 3.53 -0.99 on a 5-5 scale where 1 = poor and 5 = excellent, p < 0.0001). Fellows who had a rotation in palliative care during fellowship (44.9%) reported better teaching on managing a patient at EOL than those who did not (3.91 -1.0 versus 3.21 -0.87, p < 0.0001). Fellows reporting better teaching in EOL care felt better prepared to care for patients at EOL (r = 0.52, p < 0.0001). More than 25% reported not being explicitly taught how to assess prognosis, when to refer a patient to hospice, or how to conduct a family meeting to discuss treatment options. Conclusion: Many recent oncology fellows are still inadequately prepared to provide palliative care to their patients. There is significant room for improvement with regards to the quality of palliative care training in U.S. hematology/oncology fellowship programs.

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The need for end-of-life care training in nephrology: national survey results of nephrology fellows

Cited by 158 publications

References 10 publications

Nephrologists’ Reported Preparedness for End-of-Life Decision-Making

Nephrologists’ Reported Preparedness for End-of-Life Decision-Making

Dialysis in Late Life

Palliative Care Training during Fellowship: A National Survey of U.S. Hematology and Oncology Fellows

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