Advance Care Planning for Adults With CKD: A Systematic Integrative Review

Luckett, Tim; Sellars, Marcus; Tieman, Jennifer; Pollock, Carol; Silvester, William; Butow, Phyllis; Detering, Karen; Brennan, Frank; Clayton, Josephine M.

doi:10.1053/j.ajkd.2013.12.007

Cited by 97 publications

(110 citation statements)

References 87 publications

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“…Given the extent of comorbidity, matching patients' goals of care with the care provided throughout their disease course is of particular importance for dialysis patients. Engaging patients and families in iterative discussions about advance care planning (ACP) across the course of their illness can help increase the likelihood that patients' care goals are met (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

“…Many dialysis patients and their families wish to discuss ACP with their health care providers, and such discussions are associated with positive patient outcomes (7). However, despite the existence of tools to foster such discussions (8), ACP for dialysis patients remains suboptimal (7,9,10).…”

Section: Introductionmentioning

confidence: 99%

“…However, despite the existence of tools to foster such discussions (8), ACP for dialysis patients remains suboptimal (7,9,10). Barriers to dialysis team members initiating ACP discussions exist, but many are modifiable (7).…”

Section: Introductionmentioning

confidence: 99%

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Advance Care Planning

Goff

Eneanya

Feinberg

et al. 2015

Clinical Journal of the American Society of Nephrology

102

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Background and objectives More than 90,000 patients with ESRD die annually in the United States, yet advance care planning (ACP) is underutilized. Understanding patients' and families' diverse needs can strengthen systematic efforts to improve ACP.Design, setting, participants, & measurements In-depth interviews were conducted with a purposive sample of patients and family/friends from dialysis units at two study sites. Applying grounded theory, interviews were audiotaped, professionally transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized into major themes and subthemes.Results Thirteen patients and nine family/friends participated in interviews. The mean patient age was 63 years (SD 14) and five patients were women. Participants identified as black (n=1), Hispanic (n=4), Native American (n=4), Pacific Islander (n=1), white (n=11), and mixed (n=1). Three major themes with associated subthemes were identified. The first theme, "Prior experiences with ACP," revealed that these discussions rarely occur, yet most patients desire them. A potential role for the primary care physician was broached. The second theme, "Factors that may affect perspectives on ACP," included a desire for more of a connection with the nephrologist, positive and negative experiences with the dialysis team, disenfranchisement, life experiences, personality traits, patient-family/friend relationships, and power differentials. The third theme, "Recommendations for discussing ACP," included thoughts on who should lead discussions, where and when discussions should take place, what should be discussed and how.Conclusions Many participants desired better communication with their nephrologist and/or their dialysis team. A number expressed feelings of disenfranchisement that could negatively impact ACP discussions through diminished trust. Life experiences, personality traits, and relationships with family and friends may affect patient perspectives regarding ACP. This study's findings may inform clinical practice and will be useful in designing prospective intervention studies to improve patient and family experiences at the end of life.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Advance Care Planning

Goff

Eneanya

Feinberg

et al. 2015

Clinical Journal of the American Society of Nephrology

102

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“…In addition, more involvement of other important health-care providers, nurses, and social workers in shared clinical decision process along with multiple conversations with the family members, would facilitate incorporation of conservative CKD care, and educate the patients’ family regarding the best appropriate medical care for their sick family member [11,34]. Under adequate palliative care and provision of CKD care other than dialysis, most uremic symptoms can be controlled to an acceptable level and dialysis treatment might need to be provided only in rare occasions of pulmonary edema [35]. …”

Section: Discussionmentioning

confidence: 99%

Provision of renal care for patients with end stage kidney disease in persistent vegetative state, in United Arab Emirates: a national survey of renal physicians

Alshamsi

Chaaban

Alrukhaimi

et al. 2018

Libyan Journal of Medicine

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Patients with end stage kidney disease (ESKD) with severely impaired cognitive function have no survival benefit from dialysis. We therefore undertook a survey to explore the renal physicians’ practices of withholding and withdrawal of dialysis treatment in vegetative state patients in the United Arab Emirates (UAE). A cross sectional survey of 29 nephrology practices in UAE exploring physicians’ practices in making decisions of withholding and withdrawal of dialysis treatment during provision end-of-life care for patients in persistent vegetative state (PVS).The majority of participants practice in governmental non-for-profit dialysis units (79%), and think they are well prepared to make decision with patients and family on issues of dialysis withdrawal and withholding (69%). If a chronic dialysis patient became permanently unconscious only few respondents (17%) indicated probability of stopping dialysis. On the other hand, more respondents (48%) reported that dialysis is likely to be withheld in PVS patients who develop kidney failure. In high risk or poor prognosis ESKD patients and given how likely they would consider each option independently, respondents reported they are likely to consider time-limited dialysis in 78% of the time followed by stopping (46%) or forgoing (27%) dialysis. Majority of the participants perceived that their decisions in providing renal care for PVS patients in UAE were influenced by the family sociocultural beliefs (76% of participants), the current hospital policies (72% of participants), and by Islamic beliefs (66% of participants). Only few perceived access to palliative care (30%) and treatment cost (17%) to have an impact on their decision making.Decisions of initiation and continuation of dialysis treatment to ESKD patients in PVS are prevalent among nephrology practices in UAE. Development of local guidelines based on the societal values along with early integration of palliative kidney failure management care would be required to improve the quality of provision of end-of-life renal care in UAE.Abbreviations: ESKD: stage kidney disease; UAE: United Arab Emirates; PVS: persistent vegetative state; RPA: Renal Physicians Association; ASN: American Society of Nephrology; EMAN: Emirates Medical Association Nephrology Society; CPR: cardiopulmonary resuscitation.

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“…A recent systematic review 21 found some evidence that ACP led to increased well-being and reduced anxiety amongst patients and families. However, most studies were descriptive, and intervention studies measured a limited set of outcomes.…”

Section: Background and Rationalementioning

confidence: 99%

EAPC2016: Abstracts

2016

Palliat Med

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Advance Care Planning for Adults With CKD: A Systematic Integrative Review

Abstract: Background

Cited by 97 publications

References 87 publications

Advance Care Planning

Advance Care Planning

Provision of renal care for patients with end stage kidney disease in persistent vegetative state, in United Arab Emirates: a national survey of renal physicians

EAPC2016: Abstracts

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