Association of Family Ratings of Quality of End-of-Life Care With Stopping Dialysis Treatment and Receipt of Hospice Services

Richards, Claire; Hebert, Paul L.; Liu, Chuan‐Fen; Ersek, Mary; Wachterman, Melissa; Taylor, Larry E.; Reinke, Lynn F.; O’Hare, Ann M.

doi:10.1001/jamanetworkopen.2019.13115

Cited by 15 publications

(24 citation statements)

References 70 publications

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“…Previous studies exploring perceived prognosis in patients on hemodialysis have all been based in North America, 2 , 7 , 29 , 30 , 31 where palliative care and nephrology are often viewed as distinct and opposing care options. 35 Practice in the United Kingdom has changed significantly over the last 2 decades, with a greater acceptance and desire for symptom control and palliative care input in patients with advanced kidney disease. 36 , 37 , 38 The importance of improved risk communication with patients has also been widely recognized and embraced.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of Illness Severity, Treatment Goals, and Life Expectancy: The ePISTLE Study

Beckwith

Adwaney

Appelbe

et al. 2021

Kidney International Reports

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Section: Discussionmentioning

confidence: 99%

Perceptions of Illness Severity, Treatment Goals, and Life Expectancy: The ePISTLE Study

Beckwith

Adwaney

Appelbe

et al. 2021

Kidney International Reports

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“…As described elsewhere, we used clinical and administrative data from the VA, Medicare, and the US Renal Data System, a national ESKD registry, to assemble and characterize the cohort. 10,13 Patients entered the cohort on the date of their second eGFR ,20 ml/min per 1.73 m 2 during the observation period and were followed through their date of death or most recent documented clinical encounter within the VA system on or before October 8, 2019.…”

Section: Methodsmentioning

confidence: 99%

“…3,7 Infrequent and late hospice referral among patients on maintenance dialysis have been attributed to a Medicare payment policy that will not provide reimbursement for life-sustaining treatments related to the primary hospice diagnosis, 8 effectively forcing patients dying of kidney failure to choose between hospice and dialysis. 3,4,9 However, rates of hospice enrollment are also low in veterans on maintenance dialysis 10 and among patients with advanced kidney disease not on dialysis, 5 groups that should theoretically be less affected by Medicare payment rules around concurrent care. Thus, other considerations may also be important in understanding limited use of hospice services among patients with advanced kidney disease.…”

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confidence: 99%

Thematic Analysis of Hospice Mentions in the Health Records of Veterans with Advanced Kidney Disease

O’Hare

Butler

Taylor

et al. 2020

JASN

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BackgroundPatients with advanced kidney disease are less likely than many patients with other types of serious illness to enroll in hospice. Little is known about real-world clinical decision-making related to hospice for members of this population.MethodsWe used a text search tool to conduct a thematic analysis of documentation pertaining to hospice in the electronic medical record system of the Department of Veterans Affairs, for a national sample of 1000 patients with advanced kidney disease between 2004 and 2014 who were followed until October 8, 2019.ResultsThree dominant themes emerged from our qualitative analysis of the electronic medical records of 340 cohort members with notes containing hospice mentions: (1) hospice and usual care as antithetical care models: clinicians appeared to perceive a sharp demarcation between services that could be provided under hospice versus usual care and were often uncertain about hospice eligibility criteria. This could shape decision-making about hospice and dialysis and made it hard to individualize care; (2) hospice as a last resort: patients often were referred to hospice late in the course of illness and did not so much choose hospice as accept these services after all treatment options had been exhausted; and (3) care complexity: patients’ complex care needs at the time of hospice referral could complicate transitions to hospice, stretch the limits of home hospice, and promote continued reliance on the acute care system.ConclusionsOur findings underscore the need to improve transitions to hospice for patients with advanced kidney disease as they approach the end of life.

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“…2 For patients continuing dialysis until death, hospice usage plummets further (18% versus 58%). 3 Dialysis seemingly contravenes traditional hospice tenets of prioritising comfort over life prolongation. The dilemma of withdrawing dialysis to enter hospice, or continue dialysis but forgo hospice, is a disservice to patients who are seeking a transition to comfort-driven care, yet would benefit symptomatically, psychologically and prognostically from dialysis.We describe a case of a patient on peritoneal dialysis (PD) with concomitant malignancy, who restarted PD in an inpatient hospice after initial dialysis withdrawal.The patient was a 78-year-old man with lung adenocarcinoma with metastases to brain and pleura.…”

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confidence: 99%

Palliative dialysis in hospice: A paradox or promising answer?

Ho¹,

Yung

See

et al. 2022

Ann Acad Med Singap

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LETTER TO THE EDITORDear Editor, End-stage renal disease (ESRD) patients have higher mortality, hospital admissions and invasive procedures towards the end of life. 1 However, many of them (82%) prioritise minimising suffering over life prolongation. Although twice as many patients prefer dying at home and inpatient hospice (65%) compared to hospital (27%), hospice utilisation remains lower for dialysis patients (20%) compared to those with cancer (55%) and heart failure (39%). 2 For patients continuing dialysis until death, hospice usage plummets further (18% versus 58%). 3 Dialysis seemingly contravenes traditional hospice tenets of prioritising comfort over life prolongation. The dilemma of withdrawing dialysis to enter hospice, or continue dialysis but forgo hospice, is a disservice to patients who are seeking a transition to comfort-driven care, yet would benefit symptomatically, psychologically and prognostically from dialysis.We describe a case of a patient on peritoneal dialysis (PD) with concomitant malignancy, who restarted PD in an inpatient hospice after initial dialysis withdrawal.The patient was a 78-year-old man with lung adenocarcinoma with metastases to brain and pleura. He was on PD for ESRD secondary to diabetic kidney disease.Seventeen days into second-line chemotherapy, he was admitted to hospital for delirium and functional decline. Considering the rapid deterioration, his oncologist advised for best supportive care and gave a prognosis of 3 months. He concurrently developed recurrent intradialytic hypotension, rendering PD unsafe. A goals-of-care discussion was conducted with his wife, and PD was withdrawn. Unfortunately, the patient's delirium prevented his participation in this discussion.He was transferred to our inpatient hospice, where his haemodynamics and confusion significantly improved. He could communicate his wishes coherently and consistently. He desired to continue PD until medically contraindicated, while shifting care goals towards prioritising comfort, as he was cognisant of the limited prognosis portended by his incurable malignancy. After discussion with his oncologist, nephrologist and palliative care physician, we restarted PD in our inpatient hospice.

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Association of Family Ratings of Quality of End-of-Life Care With Stopping Dialysis Treatment and Receipt of Hospice Services

Abstract: This survey study examines the association of family-rated quality of end-of-life care with stopping dialysis treatment and receipt of hospice services among veterans with end-stage renal disease.

Cited by 15 publications

References 70 publications

Perceptions of Illness Severity, Treatment Goals, and Life Expectancy: The ePISTLE Study

Perceptions of Illness Severity, Treatment Goals, and Life Expectancy: The ePISTLE Study

Thematic Analysis of Hospice Mentions in the Health Records of Veterans with Advanced Kidney Disease

Palliative dialysis in hospice: A paradox or promising answer?

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