Extremely ill dialysis patients have marked symptom burden, considerably impaired HRQoL and frequently lack advance directives, making them appropriate candidates for palliative care. Patients and nephrologists perceive palliative care favourably despite its lack of effect in this study. A more sustained palliative care intervention with a larger sample size should be attempted to determine its effect on the care of this population.

Medical students experienced patient deaths as emotionally powerful even when they were not close to the patients. Debriefing sessions with students were rare, and many students felt inadequately supported. Thus, a unique opportunity to teach about death, emotions and coping with stress is often lost.