Five Policies to Promote Palliative Care for Patients with ESRD

Abstract

SummaryPatients with ESRD experience complex and costly care that does not always meet their needs. Palliative care, which focuses on improving quality of life and relieving suffering for patients with serious illnesses, could address a large unmet need among patients with ESRD. Strengthening palliative care is a top policy priority for health reform efforts based on strong evidence that palliative care improves value. This commentary outlines palliative care policies for patients with ESRD and is directed at policymakers, dialysis providers, nephrology professional societies, accreditation organizations, and funding agencies who play a key role in the delivery and determination of quality of ESRD care. Herein we suggest policies to promote palliative care for patients with ESRD by addressing key barriers, including the lack of access to palliative care, lack of capacity to deliver palliative care, and a limited evidence base. We also provide examples of how these policies could be implemented within the existing ESRD care infrastructure.

SPIRIT trial: A phase III pragmatic trial of an advance care planning intervention in ESRD

“…Dialysis care providers currently practice within the guidelines of the Medicare End-Stage Renal Disease Quality Incentive Program, which includes metrics related to infections, anemia, and urea clearance. Although clinical practice guidelines and the National Quality Foundation strongly endorse ACP as a quality indicator, ACP is not a clinical benchmark for care of ESRD patients [2, 60]. In fact, very little is known about implementing an efficacious ACP intervention in dialysis clinical practice [61].…”

Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis

“…When optimally used, palliative care is introduced early in the disease trajectory and is provided in conjunction with disease modifying treatments. 17 - 19 As the disease progresses along the trajectory, the focus of care shifts, gradually, from disease-modification to symptom management and focuses largely on the individual patient’s experience. ESKD is well recognized as a serious and life-limiting illness with a high symptom burden.…”

Palliation Versus Dialysis for End-Stage Renal Disease in the Oldest Old: What are the Considerations?

“…45 As noted above, the current measures focus on the quality of the HD being performed, without regard for appropriateness of initiating or maintaining therapy. To be formally included in the ESRD Quality Incentive Program, a quality measure must be supported by the National Quality Forum, which has previously endorsed several measures related to palliative care that could be appropriate for the ESRD Quality Incentive Program.…”