Pathways to palliative care for patients with chronic kidney disease

Bull, Rosalind, Youl, Loren, Robertson, Iain K., Mace, Rose, Challenor, Sarah and Fassett, Robert G. (2014) Pathways to palliative care for patients with chronic kidney disease. Journal of Renal Care, 40 1: 64-73. doi:10.1111/jorc.12049


Author Bull, Rosalind
Youl, Loren
Robertson, Iain K.
Mace, Rose
Challenor, Sarah
Fassett, Robert G.
Title Pathways to palliative care for patients with chronic kidney disease
Journal name Journal of Renal Care   Check publisher's open access policy
ISSN 1755-6678
1755-6686
Publication date 2014-03
Year available 2014
Sub-type Article (original research)
DOI 10.1111/jorc.12049
Open Access Status
Volume 40
Issue 1
Start page 64
End page 73
Total pages 10
Place of publication Paris, France
Publisher European Dialysis and Transplant Nurses Association, European Renal Care Association
Collection year 2015
Language eng
Formatted abstract
SUMMARY
Background

Despite the terminal nature of chronic kidney disease (CKD), end-of-life care planning is often inconsistent and pathways to palliative care are unclear. Health professionals' perceptions of palliative care and the prevailing context may influence their end-of-life decision making.

Objectives
To identify predictors of conservative treatment decisions and their associations with referral to palliative care, and to determine the perceptions that health professionals have about the role of palliative care in management of CKD.

Methods
A retrospective audit of deceased patients' charts, spanning three years, and a survey of renal healthcare professionals, documenting CKD palliative care practices, knowledge and attitudes was carried out. Records of all patients with CKD dying between 1 January 2006 and 31 December 2008 in Australian regional renal service were audited. Renal staff from the service were surveyed. Logistic regression for binomial outcomes and ordinal logistic regression when more than two outcome levels were involved; and thematic analysis using a continual cross comparative approach was undertaken.

Results
Loss of function, particularly from stroke, and severe pain are interpreted as representing levels of suffering which would justify the need to withdraw from renal replacement therapy. Family and/or patient indecision complicates and disrupts end-of-life care planning and can establish a cycle of ambiguity. Whilst renal healthcare professionals support early discussion of end-of-life care at predialysis education, congruity with the patient and family when making the final decision is of great importance.

Conclusion
Healthcare professionals' beliefs, values and knowledge of palliative care influence their end-of-life care decisions. The influence of patient, family and clinicians involves negotiation and equivocation. Health professionals support the early discussion of end-of-life care in CKD at predialysis education to enable clearer decision making.
Keyword Chronic kidney disease
Palliative care
Withdrawal
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Human Movement and Nutrition Sciences Publications
School of Medicine Publications
 
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