Unique palliative care needs of patients with advanced chronic kidney disease – the scope of the problem and several solutions

Sturgill, Daniel; Bear, Alexandria

doi:10.7861/clinmedicine.19-1-26

Cited by 14 publications

(11 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The findings add to the literature documenting less frequent and less timely use of hospice services among patients with ESKD compared with patients with other serious advanced illnesses, including cancer and congestive heart failure. [13][14][15][16][17][18][19][20] Less frequent and timely use of hospice services is concerning because past research among other patient populations suggests that hospice initiation and longer hospice stays are associated with higher quality end-of-life care and more favorable bereavement outcomes. [21][22][23][24] Several prior studies that have examined concurrent care among veterans with advanced cancer receiving cancer-focused therapies suggest that this approach may help to improve the quality of end-of-life care.…”

Section: Discussionmentioning

confidence: 99%

Association of Hospice Payer With Concurrent Receipt of Hospice and Dialysis Among US Veterans With End-stage Kidney Disease

et al. 2022

View full text Add to dashboard Cite

ImportanceFor many patients with end-stage kidney disease (ESKD), the Medicare Hospice Benefit precludes concurrent receipt of hospice and dialysis services, forcing patients to choose between continuing dialysis or enrolling in hospice. Whether the more liberal hospice eligibility criteria of the Veterans Health Administration’s (VA) are associated with improved access to concurrent dialysis and hospice care for patients with ESKD is not known.ObjectiveTo examine the frequency of concurrent hospice and dialysis care among US veterans by hospice payer and examine the payer for concurrent dialysis.Design, Setting, and ParticipantsThis was a retrospective cross-sectional study of all 70 577 VA enrollees in the US Renal Data System registry who initiated maintenance dialysis and died in 2007 to 2016. Data were analyzed from April 2021 to August 2022.ExposuresHospice payer, either Medicare, VA inpatient hospice, or VA-financed community-based hospice (“VA community care”). Primary hospice diagnosis–ESKD vs non-ESKD.Main Outcomes and MeasuresConcurrent receipt of hospice and dialysis services (“concurrent care”).ResultsThere were 18 420 (26%) eligible veterans with ESKD who received hospice services (mean [SD] age, 75.4 [10.0] years; 17 457 [94.8%] men; 2997 [16.3%] Black, 15 162 [82.3%] White, and 261 (1.4%) individuals of other races). Most of the sample (n = 16 465; 89%) received hospice services under Medicare and 5231 (28%) continued to receive dialysis after hospice initiation. The adjusted proportion of veterans receiving concurrent care was higher for those enrolled in VA inpatient hospice or VA community care hospice than it was for those enrolled in Medicare hospice (57% and 41% vs 24%, respectively; both P &lt; .001). Regardless of hospice payer, the majority (87%) of the dialysis treatments after hospice initiation were financed by the VA, including for Medicare beneficiaries who had a hospice diagnosis other than ESKD. Median hospice length of stay was 43 days for veterans who received concurrent dialysis vs 4 days for those who did not.Conclusions and RelevanceIn this retrospective cross-sectional study of US veterans with ESKD, a substantially higher proportion of veterans in VA-financed hospice received 1 or more dialysis treatments after hospice initiation than those enrolled in Medicare-financed hospice. Regardless of hospice payer, the VA financed most concurrent dialysis treatments. Hospice users who received concurrent dialysis care had substantially longer hospice lengths of stay than those who did not. These findings suggest that Medicare hospice policy may substantially restrict access to concurrent hospice and dialysis care among veterans with ESKD.

show abstract

Section: Discussionmentioning

confidence: 99%

Association of Hospice Payer With Concurrent Receipt of Hospice and Dialysis Among US Veterans With End-stage Kidney Disease

et al. 2022

View full text Add to dashboard Cite

show abstract

“…In the same way, the possibility of choosing alternative treatments is increasing. Sturgill and Bear (2019) outlined the problem of unmet palliative care needs for patients with kidney failure and barriers to improving palliative care from the physician's point of view. It emerged that there are some disincentives to palliative care in the CKD population: Underdeveloped models of care for severely ill patients with CKD, misaligned incentives between dialysis and palliative care, and uneven access to speciality palliative care (this last specifically in the United States of America).…”

Section: Tonkinmentioning

confidence: 99%

“…In contrast, the most developed model of outpatient palliative nephrology comes from Australia, where patients are followed by multidisciplinary teams comprising palliative care and nephrology specialists (Sturgill & Bear, 2019).…”

Section: Tonkinmentioning

confidence: 99%

Nurse‐perceived facilitators and barriers to palliative care in patients with kidney disease: A European Delphi survey

Barbieri

Strini

Noble

et al. 2021

Journal of Renal Care

View full text Add to dashboard Cite

Background:The palliative care phenomenon is increasingly invested in all medicine and nursing fields, as care for people with kidney disease who do not wish to embark on dialysis: it encompasses a palliative approach to shared decision-making. To deliver patient-centred optimal care, nephrology healthcare staff should be knowledgeable about palliative care and the appropriate conservative management approach.

show abstract

“…Moreover, the reduced life expectancy of these patients with Stage 4-5 CKD must be taken into account in organizing the care offer, especially access to supportive and end-of-life care (15,(18)(19)(20). Finally, the specificities of this population require a careful, though necessary, medico-economic approach (21).…”

Section: Introductionmentioning

confidence: 99%

What does the French REIN registry tell us about Stage 4-5 CKD care in older adults?

Moranne

Hamroun²,

Couchoud³

2023

Front. Nephrol.

View full text Add to dashboard Cite

The aim of this paper is to illustrate all the clinical epidemiology searches made within the French network REIN to improve CKD stage 4-5 care in older adults. We summarize various studies describing clinical practice, care organization, prognosis and health economics evaluation in order to develop personalized care plans and decision-making tools. In France, for 20 years now, various databases have been mobilized including the national REIN registry which includes all patients receiving dialysis or transplantation. REIN data are indirectly linked to the French administrative healthcare database. They are also pooled with data from the PSPA cohort, a multicenter prospective cohort study of patients aged 75 or over with advanced CKD, monitored for 5 years, and the CKD-REIN clinical-based prospective cohort which included 3033 patients with CKD stage 3-4 from 2013 to 2016. During our various research work, we identified heterogeneous trajectories specific to this growing older population, raising ethical, organizational and economic issues. Renal registries will help clinicians, health providers and policy-makers if suitable decision- making tools are developed and validated.

show abstract

Unique palliative care needs of patients with advanced chronic kidney disease – the scope of the problem and several solutions

Cited by 14 publications

References 17 publications

Association of Hospice Payer With Concurrent Receipt of Hospice and Dialysis Among US Veterans With End-stage Kidney Disease

Association of Hospice Payer With Concurrent Receipt of Hospice and Dialysis Among US Veterans With End-stage Kidney Disease

Nurse‐perceived facilitators and barriers to palliative care in patients with kidney disease: A European Delphi survey

What does the French REIN registry tell us about Stage 4-5 CKD care in older adults?

Contact Info

Product

Resources

About