Practice Change Is Needed for Dialysis Decision Making with Older Adults with Advanced Kidney Disease

Scherer, Jennifer S.; Moss, Alvin H.

doi:10.2215/cjn.08770816

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…6e9 Given this disconnect, innovative models of care that offer comprehensive treatment with a focus on QOL, support of conservative management (nondialytic therapy of ESRD with incorporation of palliative care), and attention to patient-centered outcomes are needed for optimal management of kidney disease. 10 Palliative care is an essential part of these innovative care models. Palliative care is specialized medical care delivered by an interdisciplinary team that focuses on QOL through expert symptom control, assistance with shared decision making, facilitation of advance care planning, and provision of social and spiritual supports for patients and families living with serious illness.…”

Section: Introductionmentioning

confidence: 99%

Building an Outpatient Kidney Palliative Care Clinical Program

Scherer

Wright

Blaum

et al. 2018

Journal of Pain and Symptom Management

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The development of a model of care that provides a new approach to clinical practice requires attention to relevant stakeholder concerns. Participatory action research is a useful methodological approach that engages stakeholders and builds partnerships. This creation of shared ownership can facilitate innovation and practice change. We synthesized stakeholder concerns to build a conceptual model for an integrated nephrology and palliative care clinical program.

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Section: Introductionmentioning

confidence: 99%

Building an Outpatient Kidney Palliative Care Clinical Program

Scherer

Wright

Blaum

et al. 2018

Journal of Pain and Symptom Management

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“…Hence, dialysis is a “destination therapy” for most patients with end‐stage renal disease (ESRD). These patients often have unrecognized symptom needs, multimorbidity, and frailty; all of which further impact their experience and mortality . Nephrologists should then feel comfortable providing patient‐centered care especially at the end of life (EOL).…”

Section: Introductionmentioning

confidence: 99%

A practical guide for the care of patients with end‐stage renal disease near the end of life

Bansal

Schell

2018

Seminars in Dialysis

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Most patients who rely on dialysis for treatment of end-stage renal disease (ESRD) never receive a kidney transplant. Therefore, it is important for nephrology providers to feel comfortable discussing the role of dialysis near the end of life (EOL). Advance care planning (ACP) is an ongoing process of learning patient values and goals in an effort to outline preferences for current and future care. This review presents a framework for how to incorporate ACP in the care of dialysis patients throughout the kidney disease course and at the EOL. Early ACP is useful for all dialysis patients and should ideally begin in the absence of clinical setbacks. Check-in conversations can be used to continue longitudinal discussions with patients and identify opportunities for symptom management and support. Lastly, triggered ACP is useful to clarify care preferences for patients with worsening clinical status. Practical tools include prognostication models to identify patients at risk for decline; ACP documents to operationalize patient care preferences; and communication guidance for engaging in these important conversations. Interdisciplinary teams with expertise from social work, palliative care, and hospice can be helpful at various stages and are discussed here.

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