Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis

Abstract

Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients.

End of Life, Withdrawal, and Palliative Care Utilization among Patients Receiving Maintenance Hemodialysis Therapy

“…To involve patients and family in the decision-making process, advance care planning needs to be regularly discussed and initiated early in the disease course (28). Unfortunately, advance directives are underutilized in this population and largely devoid of references to dialysis preferences (16,29). In previous studies looking at withdrawal decision-making, there was a high proportion of cases needing surrogates or physicians to make end-of-life decisions (30,31).…”

“…Thus, more granular information is needed regarding the true prevalence of HD withdrawal, the terminal course after withdrawal, and the utilization of palliative care services. Gaining a more thorough understanding of these factors can help facilitate timely goals-ofcare discussions between clinicians and patients to better meet patient preferences and ultimately improve end-of-life care for patients with ESKD (16). Therefore, the goal of this study was to examine the frequency of HD withdrawal before death, patient factors associated with withdrawal, terminal course after withdrawal, and patterns of palliative care involvement before death among patients on maintenance HD treated in an integrated health care network utilizing an integrated electronic medical records system.…”

Case‐control study of end‐of‐life treatment preferences and costs following advance care planning for adults with end‐stage kidney disease

“…Advance care planning (ACP) aims to empower patients, with the support of their caregivers, to consider and communicate their current and future treatment goals in the context of their own preferences and values. Yet ACP is estimated to occur with only 6–49% of people with chronic kidney disease (CKD) internationally.…”

Supporting and maintaining the frail patient on long-term renal replacement therapy

“…8 Despite the frequent healthcare interactions this cohort has and hence many opportunities for ACP discussions, ACP is underutilised. 9 Awareness of and engagement with ACP are increasing among nephrologists and, given the longitudinal relationship between nephrologists and their patients, ACP discussions with their primary nephrologist can be invaluable. Adverse clinical events or deterioration in chronic conditions should trigger a conversation, revisiting the patient's preferences to ensure that their current treatment remains aligned to their goals of care and may include discussion of withdrawal of dialysis.…”