Hospice Use and End-of-Life Care for Patients With End-stage Renal Disease

Abstract

38.Hogan C; Medical Payment Advisory Commission (MedPAC). Spending in the last year of life and the impact of hospice on Medicare outlays. http://www.medpac.gov/docs/default-source /contractor-reports/spending-in-the-last-year-of -life-and-the-impact-of-hospice-on-medicare -outlays-updated-august-2015-.pdf?sfvrsn=0.

KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis

“…At the current time, several payers, including Medicare, will not support concurrent hospice and long-term dialysis treatment unless a person requests hospice for a non-kidney failure-related diagnosis. 106 This brings challenges to the US environment that may only be addressed by waivers within burgeoning value-based care models or future legislation.…”

Predictors and Assessment of Hospice Use for End-Stage Renal Disease Patients in Taiwan

“…Despite hospice care being gradually recognized as a clinically appropriate treatment option for non-cancer ESRD patients, hospice services remain underutilized [ 8 ]. From the analysis in the current study, we identified a trend of extremely low hospice care utilization rates, even though increasing slightly from 0.03% in 2009 to 0.13% in 2012.…”

“…From the analysis in the current study, we identified a trend of extremely low hospice care utilization rates, even though increasing slightly from 0.03% in 2009 to 0.13% in 2012. Given the considerably higher intensity of treatment at the end of life for patients with ESRD, the issue of low access to hospice care among ESRD patients was also found in many countries when compared with other terminally ill patients [ 8 , 10 , 24 ]. Adequate capacity of institutions and health care workers, and supportive advance care planning may help to address patients’ end-of-life care needs.…”

“…Hospice and early palliative care are generally considered as an alternative and supportive care to offer symptoms relief and optimize the quality of life among ESRD patients [ 2 , 3 , 4 , 5 , 6 , 7 ]. However, discontinuing intensive dialysis and receiving hospice care can be a more difficult decision than withholding treatment, and thus, hospice remains underutilized for ESRD patients [ 8 ]. Previous studies suggested that patients who decided to forgo dialysis were most likely older with poor functional status, but most evidence was from western countries [ 9 , 10 ].…”

“…Terminally ill patients may often lack the decision-making capacity and autonomy to terminate unwanted medical interventions that prolong the dying process [ 12 ]. Advance care planning became important for patients with ESRD, particularly those patients that do not have decision-making capacity near the end-of-life and are unable to express care preferences [ 5 , 8 , 13 ]. In addition to patient clinical functional factors, other potential reasons may also affect the decision to receive hospice care, such as cross-cultural and social customs, patient- and family-related factors (e.g., inconsistency in family values, lack of information about hospice), physician-related factors (e.g., lack of understanding of the concept of withdrawing or uncertainty about implementation), or health system-related issues (e.g., lack of availability of community-based hospice care systems) [ 14 ].…”