Health care systems do not fully address needs of kidney patients, according to clinicians
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A group of kidney disease clinicians in Australia shared a perspective that their health care systems do not sufficiently address the palliative care needs of patients with kidney disease, according to published data.
Further, clinicians reported that they wanted to develop kidney supportive care services that would require a structured approach that combines palliative care and kidney supportive care as a part of kidney health service delivery.
“[Kidney supportive care] has been described as palliative care for kidney patients, with an emphasis on early, interdisciplinary and holistic care,” Kathryn Ducharlet MBBS, FRACP, PhD, nephrologist at Eastern Health, and colleagues wrote in the data published in the American Journal of Kidney Diseases. “Despite the growing evidence and call for integrated approaches between kidney and palliative care, the clinical experience and translation into practice is largely unknown.”
In an exploratory qualitative study, researchers interviewed 54 kidney disease clinicians (18 physicians, three trainees and 33 kidney disease nurses) from five public hospitals in Victoria, Australia, to determine their perspectives of kidney supportive care, palliative care and end-of-life care. Researchers also aimed to explore the strengths and limitations of current care models from the clinicians’ point of view.
The clinicians were put into nine semi-structured focus groups with one in-person interview between Feb. 6, 2017, and May 30, 2017. Researchers conducted purposive sampling and explored topics of interest as the topics arose. Using an interpretive phenomenological approach, researchers thematically analyzed data.
One main perspective the clinicians held were that their health care systems did not sufficiently address the palliative care needs of patients with kidney disease. Another theme derived from the analysis were their aspirations to create kidney supportive care to improve health care experiences for patients. Clinicians reported a similar hope for inclusive, seamless and collaborative kidney supportive care across providers.
Further, other subthemes related to limited health care included variation in the clinical scope of kidney supportive care, limited integration of palliative care and experiences of challenging and compromised provision of end-of-life care.
“From this study, it was clear that both palliative care and [kidney supportive care] were viewed as important aspects of kidney care, however, there was not a common understanding or practice,” Ducharlet and colleagues wrote. “Given the wide variation and limitations of health care systems underpinning these views, in particular the clinical resources, processes of treatment decision-making and referral and the manner of health care delivery, clinicians faced many challenges in providing patient care near the end of life.”
Researchers noted that the findings of this study may not be applicable to health care systems outside of Victoria, Australia.
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