A Novel Interprofessional Palliative Care and Geriatrics Curriculum for Nephrology Teams

Fulton, Ana Tuya; Richman, Katherine; Azar, Maroun; Sanzen, Kelley; Devine, Jessica; Ferrone, Christine; Tanzer, Joshua Ray; Lally, Kate

doi:10.1177/1049909120915462

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…This may suggest that the process of involving palliative care consultation service in patients with kidney failure should be re-examined and re-organised, with a particular emphasis being placed on collaboration between nephrologists and the palliative care team. This could be achieved through regular comprehensive prognosis assessments of all dialysis patients using established tools involving further timely referrals and a curriculum for interprofessional clinicians to exchange thoughts and ideas 65. Meanwhile, for patients under palliative care consultation service, regular meetings should be held to discuss if future inpatient palliative care or palliative home care is needed.…”

Section: Discussionmentioning

confidence: 99%

“…This could be achieved through regular comprehensive prognosis assessments of all dialysis patients using established tools involving further timely referrals and a curriculum for interprofessional clinicians to exchange thoughts and ideas. 65 Meanwhile, for patients under palliative care consultation service, regular meetings should be held to discuss if future inpatient palliative care or palliative home Open access care is needed. Moreover, to better understand patients' preferences and thoughts, advance care planning plays an important role.…”

Section: Implications and Suggestionsmentioning

confidence: 99%

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Effects of different palliative care models on decedents with kidney failure receiving maintenance dialysis: a nationwide population-based retrospective observational study in Taiwan

2023

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ObjectivesPatients with kidney failure receiving maintenance dialysis are a particularly important population and carry a heavy disease burden. However, evidence related to palliative care for patients with kidney failure receiving maintenance dialysis remains scarce, especially in regard to palliative care consultation services and palliative home care. This study aimed to evaluate the effects of different palliative care models on aggressive treatment among patients with kidney failure receiving maintenance dialysis during the end of life.DesignA population-based retrospective observational study.SettingThis study used a population database maintained by Taiwan’s Ministry of Health and Welfare in combination with Taiwan’s National Health Research Insurance Database.ParticipantsWe enrolled all decedents who were patients with kidney failure receiving maintenance dialysis from the period 1 January 2017 to 31 December 2017 in Taiwan.Main exposure measureHospice care during the 1-year period before death.Main outcome measuresEight aggressive treatments within 30 days before death, more than one emergency department visit, more than one admission, a longer than 14-day admission, admission to an intensive care unit, death in hospital, endotracheal tube use, ventilator use and need for cardiopulmonary resuscitation.ResultsA total of 10 083 patients were enrolled, including 1786 (17.7%) patients with kidney failure who received palliative care 1 year before death. Compared with patients without palliative care, patients with palliative care had significantly less aggressive treatments within 30 days before death (Estimates: −0.09, CI: −0.10 to −0.08). Patients with inpatient palliative care, palliative home care or a mixed model experienced significantly lower treatment aggressiveness within 30 days before death.ConclusionsPalliative care, particularly use of a mixed care model, inpatient palliative care and palliative home care in patients with kidney failure receiving dialysis, could all significantly reduce the aggressiveness of treatment within 30 days before death.

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Section: Discussionmentioning

confidence: 99%

Section: Implications and Suggestionsmentioning

confidence: 99%

Effects of different palliative care models on decedents with kidney failure receiving maintenance dialysis: a nationwide population-based retrospective observational study in Taiwan

2023

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“…Enhanced training and education, along with interdisciplinary collaboration, can aid in improved communication with patients requiring HD. A study by Fulton et al19 suggested that interprofessional clinicians, including nephrologists, nurses, social workers, and pharmacists, can determine early goals of care through effective communication.…”

Section: Role Of the Healthcare Teammentioning

confidence: 99%

End-stage renal disease and hemodialysis

Foy

Mang

2023

Nursing

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“…8 Fulton et al developed and evaluated an interprofessional palliative care and geriatrics curriculum for nephrology teams, concluding that IPC may result in improved management of patients with chronic kidney disease (CKD) or end-stage kidney disease. 9 A qualitative analysis of IPC between nephrologists and intensive care unit (ICU) practitioners revealed significant difficulties stemming from discordant preferences about the aggressiveness of renal replacement therapy, based on different understanding of physiology, goals of care and acuity. 10 While the coronavirus disease 2019 (COVID-19) pandemic has overrun the world with numerous cases and deaths, it has also challenged the healthcare systems, putting the existing guidelines and solutions to test.…”

Section: Introductionmentioning

confidence: 99%

Interprofessional collaboration in the renal care settings: Experiences in the COVID-19 era

Pawłowicz

Sawościan²,

Lipińska³

et al. 2022

Adv Clin Exp Med

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Background. The role of interprofessional collaboration (IPC) in healthcare is increasingly emphasized. Due to significant comorbidity in renal patients who require highly specialized procedures, proper IPC is an essential component in renal care. During the coronavirus disease 2019 (COVID-19) pandemic, the existing and proven collaboration mechanisms were put to the test.Objectives. To assess IPC in the renal care settings in the era of COVID-19 pandemic. Materials and methods.The survey consisted of the Assessment of Interprofessional Team Collaboration Scale II (AITCS-II) (3 subscales -partnership, cooperation and coordination, maximum of 5 points), questions about work conditions and factors influencing work during the pandemic, as well as demographic data. The survey was distributed in 8 renal care settings (4 hospital wards with dialysis units and 4 individual dialysis units); 127 participants filled out the survey; 26.8% of participants were physicians, 68.5% nurses and 4.7% other staff members, i.e., administrative assistants. Mean work experience in their current team was 16.8 ±11.7 years among nurses and 11.6 ±9.7 years among physicians.Results. Interprofessional collaboration was assessed by physicians and nurses, respectively, as follows: partnership 4.03 ±0.79 compared to 3.58 ±0.73 (p = 0.003), cooperation 4.28 ±0.59 compared to 3.71 ±0.72 (p = 0.0002), and coordination 3.83 ±0.87 compared to 3.48 ±0.82 (p = 0.04). The specific workplace did not influence the IPC rates; 49.9% of physicians and 40. 1% of nurses agreed or strongly agreed that the collaboration worsened during the pandemic; 47% of physicians and 42.4% of nurses admitted that the communication has significantly deteriorated. An increased level of stress, new procedures and fear of getting infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were, according to the participants, the most significant factors for the worsening of IPC.Conclusions. The exceptional circumstances faced during the pandemic have a significant impact on IPC, which may influence patients' satisfaction and safety. An active support for healthcare teams in the field of IPC is especially important in this challenging reality.

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A Novel Interprofessional Palliative Care and Geriatrics Curriculum for Nephrology Teams

Cited by 7 publications

References 18 publications

Effects of different palliative care models on decedents with kidney failure receiving maintenance dialysis: a nationwide population-based retrospective observational study in Taiwan

Effects of different palliative care models on decedents with kidney failure receiving maintenance dialysis: a nationwide population-based retrospective observational study in Taiwan

End-stage renal disease and hemodialysis

Interprofessional collaboration in the renal care settings: Experiences in the COVID-19 era

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