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Douglass-Molloy H, Law MM, Le B, Katz N. Spiritual distress in dialysis: A case report. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2090052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Brian Le
- Royal Melbourne Hospital, Victoria, Australia
- Peter MacCallum Cancer Centre, Victoria, Australia
| | - Naomi Katz
- Peter MacCallum Cancer Centre, Victoria, Australia
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Senteio CR, Callahan MB. Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning. BMC Nephrol 2020; 21:55. [PMID: 32075587 PMCID: PMC7031953 DOI: 10.1186/s12882-020-01720-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 02/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Advance Care Planning (ACP) is essential for preparation for end-of-life. It is a means through which patients clarify their treatment wishes. ACP is a patient-centered, dynamic process involving patients, their families, and caregivers. It is designed to 1) clarify goals of care, 2) increase patient agency over their care and treatments, and 3) help prepare for death. ACP is an active process; the end-stage renal disease (ESRD) illness trajectory creates health circumstances that necessitate that caregivers assess and nurture patient readiness for ACP discussions. Effective ACP enhances patient engagement and quality of life resulting in better quality of care. MAIN BODY Despite these benefits, ACP is not consistently completed. Clinical, technical, and social barriers result in key challenges to quality care. First, ACP requires caregivers to have end-of-life conversations that they lack the training to perform and often find difficult. Second, electronic health record (EHR) tools do not enable the efficient exchange of requisite psychosocial information such as treatment burden, patient preferences, health beliefs, priorities, and understanding of prognosis. This results in a lack of information available to enable patients and their families to understand the impact of illness and treatment options. Third, culture plays a vital role in end-of-life conversations. Social barriers include circumstances when a patient's cultural beliefs or value system conflicts with the caregiver's beliefs. Caregivers describe this disconnect as a key barrier to ACP. Consistent ACP is integral to quality patient-centered care and social workers' training and clinical roles uniquely position them to support ACP. CONCLUSION In this debate, we detail the known barriers to completing ACP for ESRD patients, and we describe its benefits. We detail how social workers, in particular, can support health outcomes by promoting the health information exchange that occurs during these sensitive conversations with patients, their family, and care team members. We aim to inform clinical social workers of this opportunity to enhance quality care by engaging in ACP. We describe research to help further elucidate barriers, and how researchers and caregivers can design and deliver interventions that support ACP to address this persistent challenge to quality end-of-life care.
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Affiliation(s)
- Charles R Senteio
- School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, USA.
| | - Mary Beth Callahan
- Dallas Nephrology Associates, 411 North Washington Street, Suite #7000, Dallas, TX, 75246, USA
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O'Halloran P, Noble H, Norwood K, Maxwell P, Shields J, Fogarty D, Murtagh F, Morton R, Brazil K. Advance Care Planning With Patients Who Have End-Stage Kidney Disease: A Systematic Realist Review. J Pain Symptom Manage 2018; 56:795-807.e18. [PMID: 30025939 PMCID: PMC6203056 DOI: 10.1016/j.jpainsymman.2018.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 01/02/2023]
Abstract
CONTEXT Patients with end-stage kidney disease have a high mortality rate and disease burden. Despite this, many do not speak with health care professionals about end-of-life issues. Advance care planning is recommended in this context but is complex and challenging. We carried out a realist review to identify factors affecting its implementation. OBJECTIVES The objectives of this study are 1) to identify implementation theories; 2) to identify factors that help or hinder implementation; and 3) to develop theory on how the intervention may work. METHODS We carried out a systematic realist review, searching seven electronic databases: Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Google Scholar, and ScienceDirect. RESULTS Sixty-two papers were included in the review. CONCLUSION We identified two intervention stages-1) training for health care professionals that addresses concerns, optimizes skills, and clarifies processes and 2) use of documentation and processes that are simple, individually tailored, culturally appropriate, and involve surrogates. These processes work as patients develop trust in professionals, participate in discussions, and clarify values and beliefs about their condition. This leads to greater congruence between patients and surrogates; increased quality of communication between patients and professionals; and increased completion of advance directives. Advance care planning is hindered by lack of training; administrative complexities; pressures of routine care; patients overestimating life expectancy; and when patients, family, and/or clinical staff are reluctant to initiate discussions. It is more likely to succeed where organizations treat it as core business; when the process is culturally appropriate and takes account of patient perceptions; and when patients are willing to consider death and dying with suitably trained staff.
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Affiliation(s)
- Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, United Kingdom.
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, United Kingdom
| | - Kelly Norwood
- School of Psychology, Ulster University, Coleraine Campus, Coleraine, United Kingdom
| | - Peter Maxwell
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Health Sciences Building, Belfast, United Kingdom; Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom
| | - Joanne Shields
- Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom
| | - Damian Fogarty
- Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Rachael Morton
- Sydney Medical School, University of Sydney, NSW, Australia
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, United Kingdom
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Panocchia N, Tonnara G, Minacori R, Sacchini D, Bossola M, Tazza L, Gambaro G, Spagnolo AG. Survey on advance care planning of Italian outpatients on chronic haemodialysis. BMJ Support Palliat Care 2017; 7:419-422. [PMID: 28596151 DOI: 10.1136/bmjspcare-2017-001322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/17/2017] [Accepted: 04/26/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The clinical practice guidelines published by the Renal Physicians Association (USA) recommend instituting advance care planning (ACP) for patients with end-stage renal disease. Studies on this issue are lacking in Italy. Our aim was to determine the attitudes of patients on ACP in our dialysis centre. METHODS We performed a cross-sectional survey. We recruited patients on maintenance haemodialysis (HD) at Hemodialysis Center of Università Cattolica del Sacro Cuore, from 1 March 2014 to 31 March 2015. The only exclusion criterion was inability to give an informed consent. Patients completed a questionnaire concerning their treatment preferences in three hypothetical disease scenarios: persistent vegetative state, advanced dementia, severe terminal illness; for each patients, we also collected clinical, functional and socioeconomic data. RESULTS Thirty-four HD outpatients completed the study questionnaire. The majority of respondents (85%) considered information about prognosis, health conditions and treatment options, including withdrawing dialysis, as very important and 94% of respondents considered treatment of uraemic/dialytic symptoms the most important issue. In the health scenarios provided, dialysis was the treatment least withheld. Dependence on instrumental activities of daily living (0.048) and higher Charlson Comorbidity Index scores (p=0.035) were associated with continuing dialysis in at least one scenario. CONCLUSIONS ACP should be tailored to patients' value, culture and preferences. A significant proportion of patients, however, do not want to be involved in end of life decisions. Frail elderly patients, in particular, are not inclined to interrupt dialysis, despite poor quality of life or a poor prognosis.
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Affiliation(s)
- Nicola Panocchia
- Division of Nephrology, Fondazione Policlinico Gemelli Roma, Rome, Italy
| | - Giuseppe Tonnara
- Centro Medicina Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Minacori
- Institutes of Bioethics and Medical Humanities School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Sacchini
- Institutes of Bioethics and Medical Humanities School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Bossola
- Division of Nephrology, Fondazione Policlinico Gemelli Roma, Rome, Italy
| | - Luigi Tazza
- Division of Nephrology, Fondazione Policlinico Gemelli Roma, Rome, Italy
| | - Giovanni Gambaro
- Division of Nephrology, Fondazione Policlinico Gemelli Roma, Rome, Italy
| | - Antonio Gioacchino Spagnolo
- Institutes of Bioethics and Medical Humanities School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
PURPOSE OF REVIEW Patients with progressive chronic kidney disease (CKD) have high morbidity, mortality, and symptom burden. Cardiovascular disease (CVD) and congestive heart failure (CHF) often contribute to these burdens and should be considered when providing recommendations for care. This review aims to summarize recent literature relevant to the provision of palliative and end-of-life care for patients with progressive CKD and specifically highlights issues relevant to those with CVD and CHF. RECENT FINDINGS Dialysis may not benefit older, frail patients with progressive CKD, especially those with other comorbidities. Patients managed conservatively (i.e., without dialysis) may live as long as patients who elect to start dialysis, with better preservation of function and quality of life and with fewer acute care admissions. Decisions regarding dialysis initiation should be made on an individual basis, keeping in mind each patient's goals, comorbidities, and underlying functional status. Conservative management of progressive kidney disease is frequently not offered but is likely to benefit many older, frail patients with comorbidities such as CHF and CVD. SUMMARY A palliative approach to the care of many patients with progressive CKD is essential to ensuring they receive appropriate quality care.
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Egan R, Wood S, MacLeod R, Walker R. Spirituality in Renal Supportive Care: A Thematic Review. Healthcare (Basel) 2015; 3:1174-93. [PMID: 27417819 PMCID: PMC4934638 DOI: 10.3390/healthcare3041174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/27/2015] [Accepted: 11/03/2015] [Indexed: 12/21/2022] Open
Abstract
Chronic kidney disease is marked by a reduced life expectancy and a high symptom burden. For those who reach end-stage renal disease, the prognosis is poor, and this combined with the growing prevalence of the disease necessitates supportive and palliative care programmes that will address people's psychosocial, cultural and spiritual needs. While there is variation between countries, research reveals that many renal specialist nurses and doctors are reluctant to address spirituality, initiate end-of-life conversations or implement conservative treatment plans early. Yet, other studies indicate that the provision of palliative care services, which includes the spiritual dimension, can reduce symptom burden, assist patients in making advanced directives/plans and improve health-related quality of life. This review brings together the current literature related to renal supportive care and spirituality under the following sections and themes. The introduction and background sections situate spirituality in both healthcare generally and chronic kidney disease. Gaps in the provision of chronic kidney disease spiritual care are then considered, followed by a discussion of the palliative care model related to chronic kidney disease and spirituality. Chronic kidney disease spiritual needs and care approaches are discussed with reference to advanced care planning, hope, grief and relationships. A particular focus on quality of life is developed, with spirituality named as a key dimension. Finally, further challenges, such as culture, training and limitations, are explicated.
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Affiliation(s)
- Richard Egan
- Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Sarah Wood
- Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
| | - Rod MacLeod
- Hammond Care and Northern Clinical School, University of Sydney, Sydney 2065, Australia.
| | - Robert Walker
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
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Andreassen P, Neergaard MA, Brogaard T, Skorstengaard MH, Jensen AB. The diverse impact of advance care planning: a long-term follow-up study on patients' and relatives' experiences. BMJ Support Palliat Care 2015; 7:335-340. [PMID: 26424073 DOI: 10.1136/bmjspcare-2015-000886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/24/2015] [Accepted: 09/16/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Advance care planning (ACP) is a process of discussing and recording patients' preferences for future care, aiming to guide healthcare decisions at the end of life (EOL). AIM To explore nuances in the long-term impact of ACP by studying patient and relative experiences. DESIGN A qualitative follow-up interview study. Interviews were recorded, transcribed and analysed using thematic synthesis. SETTING/PARTICIPANTS 3 patients with a life-limiting disease (lung or heart disease), affiliated with a major Danish hospital, and 7 relatives were interviewed 1 year after participating in an ACP discussion. RESULTS The experiences were diverse. Some patients and relatives felt 'relieved', 'more secure' and more in control due to ACP. To some, ACP had led to open communication rather than 'beating around the bush', and to spending more quality time together. However, others perceived ACP as irrelevant. Some stated that the patient's wishes had not been met regardless of ACP. Others felt that EOL questions cannot be realistically considered until 'you're in the middle of it', because many factors are involved. In one case, participating in ACP led to a patient-relative conflict, resulting in EOL issues being 'tucked away'. CONCLUSIONS The study reveals great diversity in patient and relative experiences of ACP. The study challenges previous research which mainly emphasises ACP as a valuable tool to optimise EOL care. This study stresses the importance of awareness of the highly individual nature of preferences and needs of patients and relatives regarding information, involvement and communication about EOL care.
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Affiliation(s)
| | | | - Trine Brogaard
- Department of Public Health, Aarhus University Hospital, Aarhus C, Denmark
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Axelsson L, Klang B, Lundh Hagelin C, Jacobson SH, Gleissman SA. Meanings of being a close relative of a family member treated with haemodialysis approaching end of life. J Clin Nurs 2014; 24:447-56. [DOI: 10.1111/jocn.12622] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Lena Axelsson
- Sophiahemmet University; Stockholm Sweden
- Division of Nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Birgitta Klang
- Division of Nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Carina Lundh Hagelin
- Sophiahemmet University; Stockholm Sweden
- Department of Learning, Informatics, Management and Ethics; Medical Management Center; Karolinska Institutet; Stockholm Sweden
| | - Stefan H Jacobson
- Division of Nephrology; Department of Clinical Sciences; Danderyd University Hospital; Karolinska Institutet; Stockholm Sweden
| | - Sissel Andreassen Gleissman
- Sophiahemmet University; Stockholm Sweden
- Department of Clinical Sciences; Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
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