Effecting Palliative Care for Chronic Kidney Disease Patients by Increasing Provider Knowledge

Abstract

Chronic kidney disease affects over 30 million Americans. In addition, thousands of patients advance from chronic kidney disease to end stage renal disease annually, which can become fatal without renal replacement therapy such as dialysis. Advance care planning and palliative care consultation can meet the needs of many patients with incurable illness by decreasing symptom burden and improving quality of life. Unfortunately, many nephrology providers focus patient care on dialysis and are not comfortable discussing advance care planning or palliative care. The project purpose was enhancing nephrology providers’ knowledge of the Renal Physician Association guidelines on Shared Decision Making in the Appropriate Initiation of and Withdrawal from Dialysis to increase advance care planning and palliative care referral to improve the quality of life of renal patients. The guidelines offer tools for providers in determining patient prognosis, facilitating advance care plans and appropriate palliative care referral. The project design was an evidence based quality initiative, not-human subjects research. Thirteen nephrology providers and nurses in the Midwest received the educational intervention in autumn 2017. Post-intervention outcomes included four renal palliative care referrals and 22 Advance Care Plans over four-months from a baseline of zero/unknown. Palliative care provides symptom relief related to renal disease and other chronic conditions, allowing patients comfort and improved quality of life. Benefits of this project to nursing and society are vast, minimizing burden on caregivers, nursing staff, and the health care system.