Renal patients at end of life: A 5-year retrospective review

Brady, Bernadette; Redahan, Lynn; Donohoe, Claire; Mellotte, George; Wall, Catherine; Higgins, Stephen P.

doi:10.1080/09699260.2017.1363451

Cited by 5 publications

(8 citation statements)

References 20 publications

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“…These findings document the slow and long decline in health experienced in those with advanced CKD regardless of whether they are receiving dialysis or not. These are also important points of differentiation between advanced CKD and terminal stages of organ failure or cancer where (i) unlike cancer, CKD is never cured; (ii) life-sustaining organ replacement therapy is available in ESKD, unlike other terminal organ failure and (iii) the differing patterns of functional decline and dependence is reflective of advanced CKD heterogeneity (Brady et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Tracking patients with advanced kidney disease in the last 12 months of life

Bonner

Chambers

Healy

et al. 2018

Journal of Renal Care

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Section: Discussionmentioning

confidence: 99%

Tracking patients with advanced kidney disease in the last 12 months of life

Bonner

Chambers

Healy

et al. 2018

Journal of Renal Care

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“…The expression “enough is enough” was used to define tipping point, (p. 5) which lent support to also considering colloquial definitions in this analysis. When a tipping point was viewed as representing negative change , some authors suggested the proper action was to prevent it . Conversely, when a tipping point was viewed as representing positive change , other authors suggested the proper action was its facilitation …”

Section: Resultsmentioning

confidence: 99%

“…When a tipping point was viewed as representing negative change, some authors suggested the proper action was to prevent it. 47,48 Conversely, when a tipping point was viewed as representing positive change, other authors suggested the proper action was its facilitation. 33,44,49 Some articles, rather than explicitly defining the term, implied the definition by applying the concept.…”

Section: Definitionsmentioning

confidence: 99%

“Tipping point” concept analysis in the family caregiving context

et al. 2019

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Aim Analyze the concept “tipping point” in the older adult family caregiving context to further knowledge about caregiving families, enhancing transdisciplinary theory, research, and practice. Background While used commonly in some disciplines, how “tipping point” has been used in health care, generally, and in relation to caregiving families, specifically, is less clear. This project was conducted to offer conceptual clarity to tipping point. Design Walker and Avant's framework. Data Source Searches of scholarly literature in PsycINFO, CINAHL, and PubMed using the search term “tipping point” in either title or abstract. Review Methods Definitions used were extracted; instances when the concept was implied but the actual term “tipping point” was not used and contexts where the term was used or implied were identified. Results The composite definition of a caregiving tipping point is a seemingly abrupt, severe, and absolute change event involving either the older adult or caregiver(s), or both that indicates a breakdown in the status quo of the caregiving system. Conclusions Transdisciplinary research, care, and policy should treat caregiving families as complex systems, use longitudinal assessments, and include colloquial communication. Early detection of impending tipping points will provide family‐centered decisional support and enhance families’ quality of life and safety.

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“…The demand from people with terminal failure across a range of solid organs is also growing in Australia although access to PCS is low with only about 30% of the total PCS being provided to non-cancer patients [ 20 ]. In response palliative care is now broadening its scope to include these patient groups [ 21 ], notwithstanding the paucity of data about their specific palliative care needs [ 22 ]. Palliative care is an important care pathway in advanced CKD (eGFR < 30 ml/min/m 2 ) as well as end stage kidney disease (ESKD eGFR < 15 ml/min/m 2 ) to manage high symptom burden [ 23 ] and the comorbid disease loads in a population characterised by increasing age and frailty.…”

Section: Introductionmentioning

confidence: 99%

“…In patients who opt not to have dialysis and instead follow a conservative care pathway, 20% are still alive 3 years later [ 26 ]. Compared with terminal cancer, the patterns of health service use [ 21 , 27 ] and functional decline [ 28 ] in advanced CKD are less predictable. These are all important points of differentiation likely to necessitate the re-design of cancer focused PCS to align with the needs of the CKD population.…”

Section: Introductionmentioning

confidence: 99%

Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5

et al. 2018

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BackgroundChronic kidney disease (CKD) is a growing global problem affecting around 10% of many countries’ populations. Providing appropriate palliative care services (PCS) to those with advanced kidney disease is becoming paramount. Palliative/supportive care alongside usual CKD clinical treatment is gaining acceptance in nephrology services although the collaboration with and use of PCS is not consistent.MethodsThe goal of this study was to track and quantify the health service utilisation of people with CKD stages 3-5 over the last 12 months of life. Patients were recruited from a kidney health service (Queensland, Australia) for this prospective, longitudinal study. Data were collected for 12 months (or until death, whichever was sooner) during 2015-17 from administrative health sources. Emergency department presentations (EDP) and inpatient admissions (IPA) (collectively referred to as critical events) were reviewed by two Nephrologists to gauge if the events were avoidable.ResultsParticipants (n = 19) with a median age of 78 years (range 42-90), were mostly male (63%), 79% had CKD stage 5, and were heavy users of health services during the study period. Fifteen patients (79%) collectively recorded 44 EDP; 61% occurred after-hours, 91% were triaged as imminently and potentially life-threatening and 73% were admitted. Seventy-four IPA were collectively recorded across 16 patients (84%); 14% occurred on weekends or public holidays. Median length of stay was 3 days (range 1-29). The median number of EDP and IPA per patient was 1 and 2 (range 0-12 and 0-20) respectively. The most common trigger to both EDP (30%) and IPA (15%) was respiratory distress. By study end 37% of patients died, 63% were known to PCS and 11% rejected a referral to a PCS. All critical events were deemed unavoidable.ConclusionsFew patients avoided using acute health care services in a 12 month period, highlighting the high service needs of this cohort throughout the long, slow decline of CKD. Proactive end-of-life care earlier in the disease trajectory through integrating renal and palliative care teams may avoid acute presentations to hospital through better symptom management and planned care pathways.

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Renal patients at end of life: A 5-year retrospective review

Cited by 5 publications

References 20 publications

Tracking patients with advanced kidney disease in the last 12 months of life

Tracking patients with advanced kidney disease in the last 12 months of life

“Tipping point” concept analysis in the family caregiving context

Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5

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