Palliative care support intervention acceptable for older adults with kidney disease
Click Here to Manage Email Alerts
Key takeaways:
- Patients had a favorable view of the palliative care intervention, the study found.
- Common themes among participants included praise for physicians’ communication skills.
A palliative care-based decision support intervention may be a beneficial for older adults with kidney disease and an acceptable strategy for nephrologists, qualitative data show.
“The emotionally taxing nature of kidney therapy decision-making affects both patients and their families and also carries moral implications for nephrologists,” Fahad Saeed, MD, a nephrologist in the divisions of nephrology and palliative care at the University of Rochester Medical Center in New York, wrote with colleagues. “Therefore, there is an urgent imperative to improve the kidney therapy decision-making process, especially for older frail adults who often benefit less from dialysis and prioritize quality of life over longevity, preferring conservative kidney management.”
Researchers interviewed 19 patients and 24 nephrologists in the chronic kidney disease-EDU study to evaluate a palliative care-based kidney therapy decision support intervention. The pilot trial followed patients aged 75 years and older with advanced CKD, defined as an eGFR of no more than 25mL/min, to aid kidney therapy and observe end-of-life decisions.
A control group in that trial received standard care and kidney therapy clinic-based education, while the intervention group had nephrologist care, a therapy decision aid and end-of-life planning. Some caregivers were also part of the study if approved by the patient.
Patients had a favorable view of the palliative care intervention, Saeed and colleagues found. Common themes among participants included praise for physicians’ communication skills, an approach to care that targets the patient, as well as the condition, and decision-making support that offers prognostic information in an accessible manner.
Nephrologists also reacted positively to the assistance of palliative care in decision-making, noting support for conservative kidney management and symptom management. However, a minority expressed concerns about involving palliative care specialists in their practice.
“Our findings are consistent with growing research indicating that palliative care intervention for older individuals with CKD and will likely be welcomed by most nephrologists; however, concerns about a third-party involvement will need to be addressed,” the researchers wrote. “Further large-scale testing of the current intervention is needed.”
Collapse
Read more about
Click Here to Manage Email Alerts