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Buur LE, Bekker HL, Madsen JK, Søndergaard H, Kannegaard M, Khatir DS, Finderup J. Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review. JBI Evid Synth 2023; 21:1582-1623. [PMID: 37278615 DOI: 10.11124/jbies-22-00261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this review was to investigate and map empirical evidence of patient involvement interventions to support patients with kidney failure making end-of-life care decisions in kidney services. INTRODUCTION Clinical guidance integrating end-of-life care within kidney failure management pathways varies. Advance care planning interventions aimed at involving patients with kidney failure in their end-of-life care planning are established in some countries. However, there is limited evidence of the other types of patient involvement interventions integrated within services to support patients with kidney failure in making decisions about their end-of-life care. INCLUSION CRITERIA This scoping review included studies exploring patient involvement interventions evaluated for patients with kidney failure considering end-of-life care, their relatives, and/or health professionals in kidney services. Studies of children under the age of 18 years were excluded. METHODS The review was informed by JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines. MEDLINE, Scopus, Embase, and CINAHL were searched for full-text studies in English, Danish, German, Norwegian, or Swedish. Two independent reviewers assessed the literature against the inclusion criteria. A relational analysis framework was used to synthesize the data extracted from the included studies, and to investigate and map different patient involvement interventions. RESULTS The search identified 1628 articles, of which 33 articles met the inclusion criteria. A total of 23 interventions were described. Interventions targeted patients (n=3); health professionals (n=8); patients and health professionals (n=5); and patients, relatives, and health professionals (n=7). Intervention components included patient resources (eg, information, patient decision aids), consultation resources (eg, advance care planning, shared decision-making), and practitioner resources (eg, communication training). Patient involvement interventions were delivered within hospital-based kidney services. CONCLUSIONS The review identified several ways to support patients with kidney failure to be involved in end-of-life care decisions. Future interventions may benefit from adopting a complex intervention framework to engage multiple stakeholders in the research and design of an intervention for shared decision-making between patients with kidney failure, their relatives, and health professionals about integrating end-of-life care options into their kidney disease management pathway.
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Affiliation(s)
- Louise Engelbrecht Buur
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- ResCenPI - Research Center for Patient Involvement, Aarhus University and Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hilary Louise Bekker
- ResCenPI - Research Center for Patient Involvement, Aarhus University and Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | | | | | | | - Dinah Sherzad Khatir
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- ResCenPI - Research Center for Patient Involvement, Aarhus University and Central Denmark Region, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Meijers B, Wellekens K, Montomoli M, Altabas K, Geter J, McCarthy K, Lobbedez T, Kazancioglu R, Thomas N. Healthcare professional education in shared decision making in the context of chronic kidney disease: a scoping review. BMC Nephrol 2023; 24:195. [PMID: 37386464 PMCID: PMC10308615 DOI: 10.1186/s12882-023-03229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023] Open
Abstract
RATIONALE & OBJECTIVE Shared decision making (SDM) is a collaborative effort between healthcare professionals, individuals with CKD whereby clinical evidence, expected outcomes and potential side-effects are balanced with individual values and beliefs to provide the best mutually decided treatment option. Meaningful SDM is supported by effective training and education. We aimed to identify the available evidence on SDM training and education of healthcare professionals caring for people with chronic kidney disease. We aimed to identify existing training programs and to explore what means are used to evaluate the quality and effectiveness of these educational efforts. METHODOLOGY We performed a scoping review to study the effectiveness of training or education about shared decision making of healthcare professionals treating patients with kidney disease. EMBASE, MEDLINE, CINAHL and APA PsycInfo were searched. RESULTS After screening of 1190 articles, 24 articles were included for analysis, of which 20 were suitable for quality appraisal. These included 2 systematic reviews, 1 cohort study, 7 qualitative studies, and 10 studies using mixed methods. Study quality was varied with high quality (n = 5), medium quality (n = 12), and low quality (n = 3) studies. The majority of studies (n = 11) explored SDM education for nurses, and physicians (n = 11). Other HCP profiles included social workers (n = 6), dieticians (n = 4), and technicians (n = 2). Topics included education on SDM in withholding of dialysis, modality choice, patient engagement, and end-of-life decisions. LIMITATIONS We observed significant heterogeneity in study design and varied quality of the data. As the literature search is restricted to evidence published between January 2000 and March 2021, relevant literature outside of this time window has not been taken into account. CONCLUSIONS Evidence on training and education of SDM for healthcare professionals taking care of patients with CKD is limited. Curricula are not standardized, and educational and training materials do not belong to the public domain. The extent to which interventions have improved the process of shared-decision making is tested mostly by pre-post testing of healthcare professionals, whereas the impact from the patient perspective for the most part remains untested.
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Affiliation(s)
- Björn Meijers
- Department of Nephrology, Department of Microbiology, Immunology and Transplantation, UZ Leuven, KU Leuven, Leuven, Belgium.
- Department of Nephrology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Karolien Wellekens
- Department of Nephrology, Department of Microbiology, Immunology and Transplantation, UZ Leuven, KU Leuven, Leuven, Belgium
| | - Marco Montomoli
- Department of Nephrology, Hospital Clínico Universitario, Valencia, Spain
| | - Karmela Altabas
- Department of Nephrology and Dialysis, UC Sisters of Mercy, Zagreb, Croatia
| | | | | | - Thierry Lobbedez
- Department of Nephrology, University Hospitals of Caen, Caen, France
| | - Rumeyza Kazancioglu
- Department of Nephrology, Bezmialem Vakif University, Istanbul, Türkiye, Turkey
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Rodriguez de Sosa G, Nicklas A, Thamer M, Anderson E, Reddy N, Stevelos J, Germain MJ, Unruh ML, Lupu DE. Implementing Advance Care Planning for dialysis patients: HIGHway project. Palliat Care 2022; 21:129. [PMID: 35841019 PMCID: PMC9286956 DOI: 10.1186/s12904-022-01011-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients undergoing hemodialysis have a high mortality rate and yet underutilize palliative care and hospice resources. The Shared Decision Making-Renal Supportive Care (SDM-RSC) intervention focused on goals of care conversations between patients and family members with the nephrologist and social worker. The intervention targeted deficiencies in communication, estimating prognosis, and transition planning for seriously ill dialysis patients. The intervention showed capacity to increase substantially completion of advance care directives. The HIGHway Project, adapted from the previous SDM-RSC, scale up training social workers or nurses in dialysis center in advance care planning (ACP), and then support them for a subsequent 9-month action period, to engage in ACP conversations with patients at their dialysis center regarding their preferences for end-of-life care. Methods We will train between 50–60 dialysis teams, led by social workers or nurses, to engage in ACP conversations with patients at their dialysis center regarding their preferences for end-of-life care. This implementation project uses the Knowledge to Action (KTA) Framework within the Consolidated Framework for Implementation Research (CFIR) to increase adoption and sustainability in the participating dialysis centers. This includes a curriculum about how to hold ACP conversation and coaching with monthly teleconferences through case discussion and mentoring. An application software will guide on the process and provide resources for holding ACP conversations. Our project will focus on implementation outcomes. Success will be determined by adoption and effective use of the ACP approach. Patient and provider outcomes will be measured by the number of ACP conversations held and documented; the quality and fidelity of ACP conversations to the HIGHway process as taught during education sessions; impact on knowledge and skills; content, relevance, and significance of ACP intervention for patients, and Supportive Kidney Care (SKC) App usage. Currently HIGHway is in the recruitment stage. Discussion Effective changes to advance care planning processes in dialysis centers can lead to institutional policy and protocol changes, providing a model for patients receiving dialysis treatment in the US. The result will be a widespread improvement in advance care planning, thereby remedying one of the current barriers to patient-centered, goal-concordant care for dialysis patients. Trial registration The George Washington University Protocol Record NCR213481, Honoring Individual Goals and Hopes: Implementing Advance Care Planning for Persons with Kidney Disease on Dialysis, is registered in ClinicalTrials.gov Identifier: NCT05324878 on April 11th, 2022.
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Affiliation(s)
| | - Amanda Nicklas
- School of Nursing, George Washington University, Washington, DC, USA
| | - Mae Thamer
- Medical Technology and Practice Patterns Institute, Bethesda, MD, USA
| | | | | | - JoAnn Stevelos
- School of Nursing, George Washington University, Washington, DC, USA
| | - Michael J Germain
- Renal and Transplant Associates of New England, PC, Springfield, MA, 01107, USA
| | - Mark L Unruh
- Department of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Dale E Lupu
- Center of Aging, Health and Humanities, George Washington University, Washington DC, USA
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Taels B, Hermans K, Van Audenhove C, Boesten N, Cohen J, Hermans K, Declercq A. How can social workers be meaningfully involved in palliative care? A scoping review on the prerequisites and how they can be realised in practice. Palliat Care Soc Pract 2021; 15:26323524211058895. [PMID: 34870204 PMCID: PMC8637690 DOI: 10.1177/26323524211058895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022] Open
Abstract
Palliative care is a holistic practice using a multidisciplinary approach in addressing multidimensional needs. Although the social aspects surrounding the end-of-life phase suggest a place for social work in it, the profession is often inadequately involved in daily practice. This contrasts strongly with the potential meaningful contributions of social workers in this field. To date, no comprehensive list of prerequisites for meaningful social work involvement in palliative care exists. This review aims to gain more insight on the prerequisites for meaningful social work involvement in palliative care and how to realise them in practice. It could therefore provide pathways for future intervention development in enhancing the involvement of social workers and maximising their contributions in palliative care. A scoping review methodology was used. A systematic selection of peer-reviewed articles ranged from 2000 to April 2021 - out of the electronic databases Web of Science, Scopus and Pubmed - was conducted. The 170 articles that met the eligibility criteria were analysed for relevant content using open and axial coding processes. The findings are reported according to the PRISMA-ScR checklist. The nine prerequisites listed in this review concern the level of individual social work capacities and the level of contextual factors structuring social work practices. A majority of articles have, however, focused on the level of individual social work capacities in a rather specialist view on palliative care. Future research should further address the contextual level of social work involvement in the broader practice of death, dying and bereavement.
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Affiliation(s)
- Brent Taels
- LUCAS – Centre for Care Research and
Consultancy, Department of Public Health and Primary Care, KU Leuven, 3000
Leuven, Belgium
| | - Kirsten Hermans
- LUCAS – Centre for Care Research and
Consultancy, Department of Public Health and Primary Care, KU Leuven,
Leuven, Belgium
| | - Chantal Van Audenhove
- LUCAS – Centre for Care Research and
Consultancy, Department of Public Health and Primary Care, KU Leuven,
Leuven, Belgium
| | - Nadine Boesten
- LUCAS – Centre for Care Research and
Consultancy, Department of Public Health and Primary Care, KU Leuven,
Leuven, Belgium
- Organisation, Policy & Social Inequalities
in Healthcare Research Group, Department of Public Health, Vrije
Universiteit Brussel, Brussel, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Department of
Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel,
Belgium
| | - Koen Hermans
- LUCAS – Centre for Care Research and
Consultancy, Department of Public Health and Primary Care, KU Leuven,
Leuven, Belgium
| | - Anja Declercq
- LUCAS – Centre for Care Research and
Consultancy, Department of Public Health and Primary Care, KU Leuven,
Leuven, Belgium
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Ahn D, Williams S, Stankus N, Saunders M. Advance care planning among African American patients on haemodialysis and their end-of-life care preferences. J Ren Care 2021; 47:265-278. [PMID: 33616278 DOI: 10.1111/jorc.12368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/17/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND African Americans in the general population have been shown to be less likely than White ethnic groups to participate in advance care planning; however, advance care planning in the population receiving dialysis has not been well explored. OBJECTIVE We examined the prevalence of African American patients receiving haemodialysis' advance care planning discussions, and whether advance care planning impacts end-of-life care preferences. DESIGN In-person interviewer-administered surveys of African American patients receiving in-centre haemodialysis. SETTING/PARTICIPANTS About 101 participants at three large dialysis organisation units in Chicago. OUTCOMES Self-reported advance care planning and preferences for life-extending treatments at end-of-life. RESULTS Most patients (69%) report no advance care planning discussions with their healthcare providers. Nearly all patients (92%) without prior advance care planning reported their healthcare providers approached them about advance care planning. While the majority of patients indicated preference for aggressive life-extending care, prior conversations about end-of-life care wishes either with family members or a healthcare provider significantly decreased patients' likelihood of choosing aggressive life-extending care across three scenarios (all p < 0.05). Significantly more patients reported that common end-of-life scenarios related to increased dependence/disability were "not worth living through" compared with those associated with increased burden on family, decreased cognitive function, and severe pain/discomfort. CONCLUSION African Americans with end-stage renal disease need more frequent, culturally-sensitive advance care planning discussions. Despite a preference for aggressive life-sustaining treatments, individuals with prior advance care planning discussions were significantly less likely to support aggressive end-of-life care. End-of-life care discussions that focus on the impact of life-extending care on patients' independence could be more concordant with the values and priorities of the African American patients.
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Affiliation(s)
- Daniel Ahn
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Shellie Williams
- Geriatrics and Palliative Care, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nicole Stankus
- Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Milda Saunders
- General Internal Medicine, University of Chicago Medicine, Section of Nephrology, Chicago, Illinois, USA
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