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Rodrigues AC, David F, Guedes R, Rocha C, Oliveira HM. Fim de vida na doença renal terminal: fatores associados ao local de óbito num programa de cuidados paliativos. J Bras Nefrol 2024; 46:93-97. [DOI: 10.1590/2175-8239-jbn-2023-0015pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024] Open
Abstract
Resumo Introdução: Os cuidados de fim de vida em doentescom doença renal terminal (DRT) podem ser desafiantes e necessitar do apoio de uma equipa especializada em cuidados paliativos (ECP). Objetivo: Caracterizar a população de doentes com DRT encaminhada à ECP e avaliar os determinantes para um fim de vida planeado no domicílio. Métodos: Realizámos um estudo de coorte observacional retrospectivo dos doentes com DRT encaminhados à ECP entre janeiro/2014 e dezembro/2021 (n = 60) e caracterizámos aqueles com DRT previamente conhecida relativamente ao local de fim de vida (n = 53). Resultados: A maioria dos pacientes eram mulheres comidade mediana de 84 anos. Metade dos doentes encontrava-se em tratamento conservador, 43% em hemodiálise crónica e os restantes suspenderam diálise iniciada agudamente. Daqueles com DRT previamente conhecida, 18% morreram em casa. Não foi objetivada associação entre género, idade, cognição, status funcional, comorbilidades, etiologia da DRC ou modalidade de tratamento da DRT e o local de óbito. A anúria e a menor sobrevida após suspensão de diálise associaram-se a um fim de vida no hospital e verificámos uma tendência para o fim de vida em casa nos doentes com mais tempo de acompanhamento pela ECP. Conclusão: O fim de vida no domicílio é possível num programa domiciliário de cuidados paliativos, independentemente de idade, sexo, etiologia da DRC, principais comorbilidades e modalidade de tratamento. A anúria e o menor tempo de sobrevida após suspensão da TRS podem ser fatores limitantes. Um acompanhamento mais longo em cuidados paliativos pode favorecer o fim de vida no domicílio.
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Rodrigues AC, David F, Guedes R, Rocha C, Oliveira HM. Dying with end stage kidney disease: factors associated with place of death on a palliative care program. J Bras Nefrol 2024; 46:93-97. [PMID: 37870397 PMCID: PMC10962416 DOI: 10.1590/2175-8239-jbn-2023-0015en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/25/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION End of life care of patients with end-stage kidney disease (ESKD) may be particularly challenging and requires the intervention of a specialized palliative care team (PCT). OBJECTIVE To characterize the population of ESKD patients referred to a PCT and evaluate the determinants of planned dying at home. METHODS We performed a retrospective observational cohort study of all patients with ESKD referred to our PCT between January 2014 and December 2021 (n = 60) and further characterized those with previously known ESKD regarding place of death (n = 53). RESULTS The majority of the patients were female and the median age was 84 years. Half of the patients were on conservative treatment, 43% were on chronic hemodialysis, and the remainder underwent hemodialysis on a trial basis and were subsequently suspended. Of those with previously known ESKD, 18% died at home and neither gender, age, cognition, performance status, comorbidities, CKD etiology, or treatment modality were associated with place of death. Anuria was significantly associated with dying at the hospital as was shorter time from dialysis suspension and death. Although not reaching statistical significance, we found a tendency towards a longer duration of palliative care follow-up in those dying at home. CONCLUSION Dying at home is possible in a palliative domiciliary program regardless of age, gender, etiology of CKD, major comorbidities, and treatment modality. Anuria and shorter survival from RRT withdrawal may be limiting factors for planned dying at home. A longer follow-up by palliative care may favor dying at home.
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Affiliation(s)
| | | | - Rita Guedes
- Hospital Pedro Hispano, Equipa de Cuidados Paliativos, Matosinhos,
Portugal
| | - Céu Rocha
- Hospital Pedro Hispano, Equipa de Cuidados Paliativos, Matosinhos,
Portugal
| | - Hugo M. Oliveira
- Hospital Pedro Hispano, Equipa de Cuidados Paliativos, Matosinhos,
Portugal
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Shayya A, Young Y. End-of-Life Medical Decisions: The Link Between Sociodemographic Characteristics and Treatment Preferences. Am J Hosp Palliat Care 2023:10499091231218988. [PMID: 38008990 DOI: 10.1177/10499091231218988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
INTRODUCTION Advance directives (ADs) promote patient autonomy in end-of-life (EOL) care, including an individual's EOL medical treatment preferences. This study aims to better understand preferences regarding EOL medical treatment among community-dwelling adults (18 and older) residing in the United States and examine the association between sociodemographic characteristics and EOL medical treatment preferences. METHODS Utilizing a cross-sectional study and snowball sampling methodology, community-dwelling adults completed a survey containing two different ADs and a questionnaire with sociodemographic information. Univariate analyses were used to summarize EOL medical treatment preferences among the sample, and bivariate analyses (Chi-square and Fisher's Exact tests) were performed to examine the association between sociodemographic characteristics (age, gender, and race/ethnicity) and EOL medical treatment preferences. RESULTS The mean age of the 166 participants was 50 (SD: 21.65, range: 18-93), with 58.4% being White and 61.4% being female. Generally, when EOL scenarios involved brain damage or a coma, more participants indicated that they did not want life-support treatment. Age and race were both associated with EOL medical treatment preferences, but no significant differences were observed in the bivariate results by gender. Largely, young and middle-aged adults, along with Black participants, were more likely to prefer more aggressive EOL medical treatments than older adults and White participants. CONCLUSION Overall, EOL medical treatment preferences varied among participants. The study findings indicate that adults develop different preferences for EOL medical treatment, with some of the variation attributable to sociodemographic characteristics such as age and race.
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Affiliation(s)
- Ashley Shayya
- Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, Rensselaer, NY, USA
| | - Yuchi Young
- Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, Rensselaer, NY, USA
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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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Li KC, Brennan F, Brown MA. Kidney failure end-of-life care: impact of advance care planning - retrospective observational study. BMJ Support Palliat Care 2023:spcare-2023-004194. [PMID: 36792344 DOI: 10.1136/spcare-2023-004194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Patients with kidney failure (KF) have poor prognosis yet receive aggressive medical interventions at the end of life. Advance care planning (ACP) aims to respect patients' treatment preference and facilitate good death, though whether these are achieved in KF is unknown.This study examines the utility of ACP for end-of-life care in KF patients. METHODS A retrospective observational study of KF patients who completed an ACP document 2012-2019 and died in an Australian hospital. Medical records were reviewed to assess treatment concordance to the ACP document and quality of end-of-life care received. RESULTS 65 KF patients (29 dialysis, 36 conservative) had a median age of 84 years and 57% males. 86% of deaths followed an emergency admission. ACP documents recorded patients' preference to avoid cardiopulmonary resuscitation (91%) and forego dialysis (86%). 95% patients received treatment concordant with ACP. One patient was resuscitated, and one conservative patient dialysed. A good quality death was achieved for most, including dialysis withdrawal (80%), palliative care referral (88%), discussion of prognosis (95%), rationalised medications (89%) and anticipatory end-of-life medications (92%). CONCLUSION ACP documents are useful facilitating treatment concordant with KF patients' preferences. Most patients avoided aggressive medical interventions and received good quality end-of-life care.
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Affiliation(s)
- Kelly Chenlei Li
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Renal Department, St George Hospital, Sydney, New South Wales, Australia
| | - Frank Brennan
- Renal Department, St George Hospital, Sydney, New South Wales, Australia
| | - Mark A Brown
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Renal Department, St George Hospital, Sydney, New South Wales, Australia
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Korfage IJ, Polinder S, Preston N, van Delden JJ, Geraerds SAJ, Dunleavy L, Faes K, Miccinesi G, Carreras G, Moeller Arnfeldt C, Kars MC, Lippi G, Lunder U, Mateus C, Pollock K, Deliens L, Groenvold M, van der Heide A, Rietjens JA. Healthcare use and healthcare costs for patients with advanced cancer; the international ACTION cluster-randomised trial on advance care planning. Palliat Med 2022; 37:707-718. [PMID: 36515362 DOI: 10.1177/02692163221142950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Advance care planning supports patients to reflect on and discuss preferences for future treatment and care. Studies of the impact of advance care planning on healthcare use and healthcare costs are scarce. AIM To determine the impact on healthcare use and costs of an advance care planning intervention across six European countries. DESIGN Cluster-randomised trial, registered as ISRCTN63110516, of advance care planning conversations supported by certified facilitators. SETTING/PARTICIPANTS Patients with advanced lung or colorectal cancer from 23 hospitals in Belgium, Denmark, Italy, the Netherlands, Slovenia and the UK. Data on healthcare use were collected from hospital medical files during 12 months after inclusion. RESULTS Patients with a good performance status were underrepresented in the intervention group (p< 0.001). Intervention and control patients spent on average 9 versus 8 days in hospital (p = 0.07) and the average number of X-rays was 1.9 in both groups. Fewer intervention than control patients received systemic cancer treatment; 79% versus 89%, respectively (p< 0.001). Total average costs of hospital care during 12 months follow-up were €32,700 for intervention versus €40,700 for control patients (p = 0.04 with bootstrap analyses). Multivariable multilevel models showed that lower average costs of care in the intervention group related to differences between study groups in country, religion and WHO-status. No effect of the intervention on differences in costs between study groups was observed (p = 0.3). CONCLUSIONS Lower care costs as observed in the intervention group were mainly related to patients' characteristics. A definite impact of the intervention itself could not be established.
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Affiliation(s)
- Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Johannes Jm van Delden
- Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Sandra A Jlm Geraerds
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Kristof Faes
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Guido Miccinesi
- Clinical Epidemiology, Oncological network, prevention and research Institute (ISPRO), Florence, Italy
| | - Giulia Carreras
- Clinical Epidemiology, Oncological network, prevention and research Institute (ISPRO), Florence, Italy
| | - Caroline Moeller Arnfeldt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Palliative Medicine, The Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Marijke C Kars
- Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | | | - Urska Lunder
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Ceu Mateus
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Palliative Medicine, The Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith Ac Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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7
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Kurella Tamura M, Holdsworth L, Stedman M, Aldous A, Asch SM, Han J, Harbert G, Lorenz KA, Malcolm E, Nicklas A, Moss AH, Lupu DE. Implementation and Effectiveness of a Learning Collaborative to Improve Palliative Care for Seriously Ill Hemodialysis Patients. Clin J Am Soc Nephrol 2022; 17:1495-1505. [PMID: 36104084 PMCID: PMC9528276 DOI: 10.2215/cjn.00090122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/11/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Limited implementation of palliative care practices in hemodialysis may contribute to end-of-life care that is intensive and not patient centered. We determined whether a learning collaborative for hemodialysis center providers improved delivery of palliative care best practices. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Ten US hemodialysis centers participated in a pre-post study targeting seriously ill patients between April 2019 and September 2020. Three practices were prioritized: screening for serious illness, goals of care discussions, and use of a palliative dialysis care pathway. The collaborative educational bundle consisted of learning sessions, communication skills training, and implementation support. The primary outcome was change in the probability of complete advance care planning documentation among seriously ill patients. Health care utilization was a secondary outcome, and implementation outcomes of acceptability, adoption, feasibility, and penetration were assessed using mixed methods. RESULTS One center dropped out due to the coronavirus disease 2019 pandemic. Among the remaining nine centers, 20% (273 of 1395) of patients were identified as seriously ill preimplementation, and 16% (203 of 1254) were identified as seriously ill postimplementation. From the preimplementation to postimplementation period, the adjusted probability of complete advance care planning documentation among seriously ill patients increased by 34.5 percentage points (95% confidence interval, 4.4 to 68.5). There was no difference in mortality or in utilization of palliative hemodialysis, hospice referral, or hemodialysis discontinuation. Screening for serious illness was widely adopted, and goals of care discussions were adopted with incomplete integration. There was limited adoption of a palliative dialysis care pathway. CONCLUSIONS A learning collaborative for hemodialysis centers spanning the coronavirus disease 2019 pandemic was associated with adoption of serious illness screening and goals of care discussions as well as improved documentation of advance care planning for seriously ill patients. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Pathways Project: Kidney Supportive Care, NCT04125537.
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Affiliation(s)
- Manjula Kurella Tamura
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
- Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Laura Holdsworth
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Margaret Stedman
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Annette Aldous
- Milkin Institute School of Public Health, George Washington University, Washington, DC
| | - Steven M. Asch
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Jialin Han
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Glenda Harbert
- School of Nursing, George Washington University, Washington, DC
| | - Karl A. Lorenz
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Elizabeth Malcolm
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Amanda Nicklas
- School of Nursing, George Washington University, Washington, DC
| | - Alvin H. Moss
- Center for Health Ethics and Law, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Dale E. Lupu
- School of Nursing, George Washington University, Washington, DC
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8
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McKie AL, Turner M, Paterson C. What are the qualitative experiences of people affected by kidney failure receiving haemodialysis? J Ren Care 2022. [PMID: 36163591 DOI: 10.1111/jorc.12442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/11/2022] [Accepted: 08/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND People affected by kidney failure receiving haemodialysis experience complexity within their health condition unlike any other chronic illness or condition. Kidney failure impacts the individual in all areas of their life including relationships and activities of daily living. OBJECTIVE To conduct a meta-aggregation of studies about the lived experiences of people with kidney failure receiving haemodialysis. DESIGN Using PRISMA Guidelines, six databases (CINAHL, ClinicalTrials.gov, Cochrane Library, MEDLINE, PsycINFO, and Scopus) were comprehensively searched using keywords and subject headings from January 1990 to October 2021. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. A meta-aggregation of qualitative findings was conducted using the Joanna Briggs Institute methodology for meta-aggregation. RESULTS Of the 9409 articles screened, 55 studies were included. This represented a total of 188 findings across 45 categories representing a range of unmet supportive care needs. The meta-aggregation identified 11 synthesised findings broadly related to psychological/emotional needs, physical needs, social needs, interpersonal/intimacy needs, patient-clinician communication needs, family related needs, health system/information needs, spiritual needs, daily living needs, practical needs and daily living needs. CONCLUSIONS This meta-aggregation has identified that people affected by kidney failure can experience a range of unmet supportive care needs. It was evident that living with kidney failure and receiving haemodialysis impacted a person's sense of self, introduced practical needs and other complex needs which were not being addressed in existing services. This review has highlighted important implications for clinical practice and future research directions.
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Affiliation(s)
- Amanda L McKie
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia.,Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Australian Capital Territory, Australia.,Griffith University, Gold Coast QLD, Australia
| | - Murray Turner
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Catherine Paterson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia.,Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Australian Capital Territory, Australia.,Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Australian Capital Territory, Australia.,Robert Gordon University, Aberdeen, Scotland, UK
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9
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Lupu DE, Aldous A, Anderson E, Schell J, Groninger H, Sherman M, Aiello J, Simmens SJ. Advance Care Planning Coaching in CKD Clinics: A Pragmatic Randomized Clinical Trial. Am J Kidney Dis 2021; 79:699-708.e1. [PMID: 34648897 DOI: 10.1053/j.ajkd.2021.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/11/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE AND OBJECTIVE Although guidelines recommend more and earlier advance care planning (ACP) for patients with chronic kidney disease (CKD), scant evidence exists to guide incorporation of ACP into clinical practice for patients not yet requiring maintenance dialysis. Involving nephrology team members in addition to primary care providers in this important patient-centered process may increase its accessibility. Our objective was to examine the effect of coaching implemented in CKD clinics on patient engagement with ACP. STUDY DESIGN Multicenter, pragmatic randomized control trial. SETTING & PARTICIPANTS Three CKD clinics in different states participated. Eligible patients were 55 years or older, had stage 3-5 CKD, and were English speaking. 273 patients consented to participate, 254 were included in analysis. INTERVENTION Nurses or social workers with experience in nephrology or palliative care delivered individualized in-person ACP sessions. The enhanced control group was given Make Your Wishes About You (MY WAY) education materials and was verbally encouraged to bring their completed advance directives to the clinic. OUTCOMES Primary outcome measures were scores on a 45-point ACP engagement scale at 14 weeks and a documented advance directive or portable medical order at 16 weeks post-enrollment. RESULTS Among 254 participants analyzed, 46.5% were 65-74 years of age and 54% had CKD stage 3. Coached patients scored 1.9 points higher at 14 weeks on the ACP engagement scale (β = 1.87; CI: 0.13-3.64) adjusted for baseline score and site. Overall, 32.8% of intervention patients (41 of 125) had an advance directive compared to 17.8% (23 of 129) of patients in the comparison group. In a site-adjusted multivariable model, coached patients were 79% more likely to have a documented advance directive or portable medical order (adjusted risk ratio = 1.79; 95% CI: 1.18-2.72), with the impact principally evident at only one study site. LIMITATIONS Small number of study sites and possible unrepresentativeness of the broader CKD population by study participants. CONCLUSIONS AND RELEVANCE Individualized coaching may be effective in enhancing ACP but its impact may be influenced by the healthcare environment where it is delivered.
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Affiliation(s)
- Dale E Lupu
- George Washington University School of Nursing.
| | - Annette Aldous
- George Washington University Milken Institute School of Public Health
| | | | | | | | | | | | - Samuel J Simmens
- George Washington University Milken Institute School of Public Health
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10
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Whitehead P, Frechman E, Johnstone-Petty M, Kates J, Tay DL, DeSanto K, Fink RM. A scoping review of nurse-led advance care planning. Nurs Outlook 2021; 70:96-118. [PMID: 34627618 DOI: 10.1016/j.outlook.2021.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/03/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Advance care planning (ACP) supports persons at any age or health status to determine their values, goals, and preferences regarding future medical care. The American Nurses Association endorses nurses to facilitate ACP to promote patient- and family-centered care. PURPOSE This project reviewed and synthesized literature on nurse-led ACP training models. METHODS A scoping review used the Arksey and O'Malley Framework to identify: (a) ACP training model type, (b) nurse-led ACP recipients, (c) ACP in special populations, (d) ACP outcomes. FINDINGS Of 33 articles reviewed, 19 included 11 established models; however, the primary finding was lack of a clearly identified evidence-based nurse-led ACP training model. DISCUSSION Nurses are integral team members, well positioned to be a bridge of communication between patients and care providers. This is a call to action for nurse leaders, researchers, educators to collaborate to identify and implement an evidence-based, effective nurse-led ACP training model.
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Affiliation(s)
- Phyllis Whitehead
- Palliative Medicine/Pain Management, Carilion Roanoke Memorial Hospital, Virginia Tech Carilion, School of Medicine, Roanoke, VA.
| | - Erica Frechman
- Palliative Care Atrium Health, PhD Candidate Nursing Science, Vanderbilt University School of Nursing, Nashville, TN
| | - Marianne Johnstone-Petty
- Palliative Care Department, Interprofessional Palliative Care Education, Providence Medical Group, Anchorage, AK
| | - Jeannette Kates
- College of Nursing, Thomas Jefferson University, Philadelphia, PA
| | - Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT
| | - Kristen DeSanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Regina M Fink
- School of Medicine and College of Nursing, Interprofessional MSPC & Palliative Care Certificate Programs, University of Colorado Anschutz Medical Campus, Aurora, CO
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11
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Buck K, Nolte L, Sellars M, Sinclair C, White BP, Kelly H, Macleod A, Detering KM. Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators. Health Expect 2021; 24:1312-1325. [PMID: 33932311 PMCID: PMC8369087 DOI: 10.1111/hex.13264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/25/2021] [Accepted: 04/02/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) conversations may result in preferences for medical care being documented. OBJECTIVE To explore the uptake and quality of advance care directives (ACDs) among older Australians accessing health and aged care services, by overall ACP documentation prevalence, person-level predictors and ACD quality indicators. DESIGN AND SETTING National multi-centre health record audit in general practices (GP), hospitals and residential aged care facilities (RACF). PARTICIPANTS A total of 4187 people aged ≥65 years attending their GP (n = 676), admitted to hospital (n = 1122) or residing in a RACF (n = 2389). MAIN OUTCOME MEASURES ACP documentation prevalence by setting and type including person-completed ACDs and non-ACD documents (completed by a health professional or someone else); person-level predictors and quality indicators of ACDs. RESULTS Overall ACP documentation prevalence was 46.5% (29.2% weighted). ACD prevalence was 25.3% (14.2% weighted). Unweighted ACD prevalence was higher in RACFs (37.7%) than in hospitals (11.1%) and GPs (5.5%). 35.8% of ACP documentation was completed by a health professional (9.7% weighted), and 18.1% was completed by someone else (10.6% weighted). Having an ACD was positively associated with being female, older, having two or more medical conditions, receiving palliative care, being divorced/separated and being in a RACF. Only 73% of ACDs included full name, signature, document date and witnessing. CONCLUSIONS AND CONTRIBUTION Low ACP documentation prevalence and a lack of accessible, person-completed and quality ACDs represent an important ACP implementation issue. Low prevalence is complicated by poor document quality and a higher prevalence of documents being completed by someone other than the person.
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Affiliation(s)
- Kimberly Buck
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
| | - Linda Nolte
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
| | - Marcus Sellars
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
- Department of Health Services Research & PolicyResearch School of Population HealthAustralian National UniversityACTAustralia
| | - Craig Sinclair
- Australian Research Council Centre of Excellence in Population Ageing ResearchUniversity of New South WalesSydneyNSWAustralia
- Neuroscience Research Australia (NeuRA)SydneyAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | - Ben P. White
- Australian Centre for Health Research LawFaculty of LawQueensland University of TechnologyBrisbaneQldAustralia
| | - Helana Kelly
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
| | - Ashley Macleod
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
| | - Karen M. Detering
- Advance Care Planning AustraliaAustin HealthHeidelbergVicAustralia
- Faculty of Health, Arts and InnovationSwinburne UniversityHawthornVic.Australia
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Tavares APDS, Santos CGDS, Tzanno-Martins C, Barros Neto J, Silva AMMD, Lotaif L, Souza JVL. Kidney supportive care: an update of the current state of the art of palliative care in CKD patients. ACTA ACUST UNITED AC 2020; 43:74-87. [PMID: 32897286 PMCID: PMC8061961 DOI: 10.1590/2175-8239-jbn-2020-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/06/2020] [Indexed: 11/24/2022]
Abstract
Chronic kidney disease (CKD) has become a public health burden worldwide for its increasing incidence and prevalence, high impact on the health related quality of life (HRQoL) and life expectancy, and high personal and social cost. Patients with advanced CKD, in dialysis or not, suffer a burden from symptoms very similar to other chronic diseases and have a life span not superior to many malignancies. Accordingly, in recent years, renal palliative care has been recommended to be integrated in the traditional care delivered to this population. This research provides an updated overview on renal palliative care from the relevant literature.
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Affiliation(s)
- Alze Pereira Dos Santos Tavares
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Hospital Santa Paula, São Paulo, SP, Brasil
| | - Cássia Gomes da Silveira Santos
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Universidade Federal do Paraná, Hospital das Clínicas, Curitiba, PR, Brasil
| | - Carmen Tzanno-Martins
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Clínica de Hemodiálise, São Paulo, SP, Brasil
| | - José Barros Neto
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Sociedade Brasileira de Nefrologia Mineira, Belo Horizonte, MG, Brasil.,Felício Rocho Hospital, Departamento de Nefrologia, Belo Horizonte, MG, Brasil
| | | | - Leda Lotaif
- Sociedade Brasileira de Nefrologia, Comitê de Cuidados Paliativos, São Paulo, SP, Brasil.,Instituto Dante Pazzanese de Cardiologia, Nefrologia e Hipertensão e Pós-Graduação, São Paulo, SP, Brasil.,HCor, São Paulo, SP, Brasil
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13
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Kinghorn P, Coast J. Appropriate frameworks for economic evaluation of end of life care: A qualitative investigation with stakeholders. Palliat Med 2019; 33:823-831. [PMID: 30916615 DOI: 10.1177/0269216319839635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of quality-adjusted life years rests on the assertion that the objective of the health care system is to improve health. AIM To elicit the views of expert stakeholders on the purpose and evaluation of supportive end of life care, and explore how different purposes of end of life care imply the need for different evaluative frameworks. DESIGN Semi-structured qualitative interviews, analysed through an economic lens using a constant comparative approach. PARTICIPANTS Twenty professionals working in or visiting the United Kingdom or Republic of Ireland, with clinical experience and/or working as academics in health-related disciplines. RESULTS Four purposes of end of life care were identified from and are critiqued with the aid of the qualitative data: to improve health, to enable patients to die in their preferred place, to enable the patient to experience a good death, and to enable the patient to experience a good death, and those who are close to the patient to have an experience which is as free as possible from fear, stress and distress. CONCLUSION Managing symptoms and reducing anxiety were considered to be core objectives of end of life care and fit with the wider health service objective of improving/maximising health. A single objective across the entire health system ensures consistency in the way that resource allocation is informed across that entire system. However, the purpose of care at the end of life is more complex, encompassing diverse and patient-centred objectives which we have interpreted as enabling the patient to experience a good death.
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Affiliation(s)
- Philip Kinghorn
- 1 Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, Edgbaston, UK
| | - Joanna Coast
- 2 Health Economics at Bristol, Population Health Sciences, Bristol Medical School, Bristol, UK
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Singh R, Hwang F, Berlin A, Pentakota SR, Singh R, Chernock B, Mosenthal AC. Patients with End-Stage Renal Disease and Acute Surgical Abdomen: Opportunities for Palliative Care. J Palliat Med 2019; 22:635-643. [DOI: 10.1089/jpm.2018.0352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roshansa Singh
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Franchesca Hwang
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ana Berlin
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sri Ram Pentakota
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ranbir Singh
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Brad Chernock
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anne C. Mosenthal
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Sellars M, Clayton JM, Detering KM, Tong A, Power D, Morton RL. Costs and outcomes of advance care planning and end-of-life care for older adults with end-stage kidney disease: A person-centred decision analysis. PLoS One 2019; 14:e0217787. [PMID: 31150504 PMCID: PMC6544277 DOI: 10.1371/journal.pone.0217787] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/17/2019] [Indexed: 11/19/2022] Open
Abstract
Background Economic evaluations of advance care planning (ACP) in people with chronic kidney disease are scarce. However, past studies suggest ACP may reduce healthcare costs in other settings. We aimed to examine hospital costs and outcomes of a nurse-led ACP intervention compared with usual care in the last 12 months of life for older people with end-stage kidney disease managed with haemodialysis. Methods We simulated the natural history of decedents on dialysis, using hospital data, and modelled the effect of nurse-led ACP on end-of-life care. Outcomes were assessed in terms of patients’ end-of-life treatment preferences being met or not, and costs included all hospital-based care. Model inputs were obtained from a prospective ACP cohort study among dialysis patients; renal registries and the published literature. Cost-effectiveness of ACP was assessed by calculating an incremental cost-effectiveness ratio (ICER), expressed in dollars per additional case of end-of-life preferences being met. Robustness of model results was tested through sensitivity analyses. Results The mean cost of ACP was AUD$519 per patient. The mean hospital costs of care in last 12 months of life were $100,579 for those who received ACP versus $87,282 for those who did not. The proportion of patients in the model who received end-of-life care according to their preferences was higher in the ACP group compared with usual care (68% vs. 24%). The incremental cost per additional case of end-of-life preferences being met was $28,421. The greatest influence on the cost-effectiveness of ACP was the probability of dying in hospital following dialysis withdrawal, and costs of acute care. Conclusion Our model suggests nurse-led ACP leads to receipt of patient preferences for end-of-life care, but at an increased cost.
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Affiliation(s)
- Marcus Sellars
- Kolling Institute, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia
- Advance Care Planning Australia, Austin Health, Melbourne, Australia
- * E-mail:
| | - Josephine M. Clayton
- Kolling Institute, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia
- HammondCare Centre for Learning & Research in Palliative Care, Greenwich Hospital, Sydney, Australia
| | - Karen M. Detering
- Advance Care Planning Australia, Austin Health, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, Victoria, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
| | - David Power
- Department of Nephrology, Austin Health, Melbourne, Australia
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
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Morton RL, Sellars M. From Patient-Centered to Person-Centered Care for Kidney Diseases. Clin J Am Soc Nephrol 2019; 14:623-625. [PMID: 30814112 PMCID: PMC6450337 DOI: 10.2215/cjn.10380818] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rachael L Morton
- National Health and Medical Research Council Clinical Trials Centre and
| | - Marcus Sellars
- Northern Clinical School, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia; and.,Advance Care Planning Australia, Austin Health, Melbourne, Australia
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