The Provider’s Role in Conservative Care and Advance Care Planning for Patients with ESRD

Obrador, Gregorio T.

doi:10.2215/cjn.03150316

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…Provider uncertainty regarding prognosis with conservative management (42) and how RRT decision making connects with the overarching need for advance care planning may have impeded these conversations (43). Enhancing the level of evidence regarding the utility of conservative management in the United States is one step to improving provider comfort with shared decision making in this setting (13,(42)(43)(44)(45).…”

Section: Discussionmentioning

confidence: 99%

Nephrology Provider Prognostic Perceptions and Care Delivered to Older Adults with Advanced Kidney Disease

Salat¹,

Javier²,

Siew³

et al. 2017

CJASN

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Section: Discussionmentioning

confidence: 99%

Nephrology Provider Prognostic Perceptions and Care Delivered to Older Adults with Advanced Kidney Disease

Salat¹,

Javier²,

Siew³

et al. 2017

CJASN

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“…However, emerging evidence shows that patients value knowledge and the opportunity to plan for potential clinical deterioration, 27 which can be difficult to predict in advanced CKD. This highlights an unmet need for earlier discussion of ESKD management options 28 as up to 70% patients are noted to enter dialysis programmes unaware of the poor prognosis conferred by ESKD. 29 Planned ESKD management options strongly correlated with the degree of frailty.…”

Section: Clinician Perceptionmentioning

confidence: 99%

Incorporating the Clinical Frailty Scale into routine outpatient nephrology practice: an observational study of feasibility and associations

Kumarasinghe

Chakera

Chan

et al. 2021

Internal Medicine Journal

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Background There is an unmet need for routine and accurate prognostication of older adults with end‐stage kidney disease (ESKD) and subsequently inadequate advance care planning. Frailty, a clinical syndrome of increased vulnerability, is predictive of adverse health outcomes in the renal population. We propose the Clinical Frailty Scale (CFS) as a feasible tool for routine use in the nephrology outpatient setting to address this unmet need. Aims To assess feasibility and associations of incorporating CFS assessment into routine outpatient nephrology practice in the pre‐dialysis setting. Methods CFS was integrated into the outpatient nephrology clinic proforma. A convenience sample of 138 patients aged >50 years, with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2, attending the outpatient service between September 2018 and April 2019 was included. Results Eighty‐one CFS assessments were completed by nephrologists, nephrology advanced trainees and clinical nurse specialists. CFS completion rates were 79% from the multidisciplinary Low Clearance Clinic and 41% from nurse‐led Pre‐dialysis Education Clinic. Planned modality of ESKD management varied with degree of frailty (P < 0.001). 21% of patients who had CFS completed were planned for Conservative Management of ESKD, in contrast to only 5% of those who did not have CFS assessment completed (P < 0.001). Conclusion Frailty assessment via CFS was feasible in outpatient practice when integrated into routine clinical assessment in a dedicated clinic. Planned ESKD management varied with the degree of frailty. Completion of frailty assessment, when compared with non‐completion, appears to be associated with increased planned conservative management of ESKD.

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“…These conversations should be embedded into chronic care management and initiated earlier in a disease process. Current evidence suggests that discussion about prognosis and EOL care are uncommon and decisionmaking is poorly integrated into primary care, which leads many patients and families being ill prepared for the EOL (Obrador, 2018). To adhere to the organization's vision of a patient centered system of care, EOL conversations with elderly patients should be normalized by PCPs and occur intuitively and frequently as counseling for other preventive services.…”

Section: Project's Clinical Sitementioning

confidence: 99%

“…However, condensed but concise conversations occurring in busy practice settings can also lead to successful ACP intervention if the patient's values and preferences are identified. Obrador (2018) explains that high quality provider-patient conversation can increase the likelihood that health care organizations will make sense and learn in ways that enable them to achieve their goals and to serve their patients in positive ways. The video download was free of charge and can be accessed from any computer or iPad in multiple clinical settings making this a versatile tool.…”

Section: Implementation In Other Clinical Settingsmentioning

confidence: 99%

A Video Decision Aid to Influence Advance Care Planning

Petry¹

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to have your friendship, inspiration, and encouragement throughout the past few years. You believed in me even when I doubted my own abilities. You pressed me to think bigger and reach higher than I believed I could and to find the determination to overcome the many challenges faced along the way. Because of that, I have cultivated greater personal and professional qualities. Most of all, I gained a friend and esteemed colleague. To my family and friends, my achievements would not be possible without the love, support, and patience you've shown throughout my academic journey. You are the reason I strive to be the best I can be. You were always my biggest fans-in good times and bad-my shoulder to cry on-my sounding board-but most importantly my source of strength during the most daunting times of this journey. For that, I offer my love and sincere gratitude.

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The Provider’s Role in Conservative Care and Advance Care Planning for Patients with ESRD

Cited by 7 publications

References 16 publications

Nephrology Provider Prognostic Perceptions and Care Delivered to Older Adults with Advanced Kidney Disease

Nephrology Provider Prognostic Perceptions and Care Delivered to Older Adults with Advanced Kidney Disease

Incorporating the Clinical Frailty Scale into routine outpatient nephrology practice: an observational study of feasibility and associations

A Video Decision Aid to Influence Advance Care Planning

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