Medline ® Abstracts for References 19,20
of 'Palliative care: End-stage renal disease'
Palliative care experience of US adult nephrology fellows: a national survey.
Shah HH, Monga D, Caperna A, Jhaveri KD
Ren Fail. 2014 Feb;36(1):39-45. Epub 2013 Sep 24.
Palliative care (PC) training and experience of United States (US) adult nephrology fellows was not known. It was also not clear whether nephrology fellows in the US undergo formal training in PC medicine during fellowship. To gain a better understanding of the clinical training and experience of US adult nephrology fellows in PC medicine, we conducted a national survey in March 2012. An anonymous on-line survey was sent to US adult nephrology fellows via nephrology fellowship training program directors. Fellows were asked several PC medicine experience and training questions. A total of 105 US adult nephrology fellows responded to our survey (11% response rate). Majority of the respondents (94%) were from university-based fellowship programs. Over two-thirds (72%) of the fellows had no formal PC medicine rotation during their medical school. Half (53%) of the respondents had no formal PC elective experience during residency. Although nearly 90% of the fellows had a division or department of PC medicine at their institution, only 46.9% had formal didactic PC medicine experience. Over 80% of the respondent's program did not offer formal clinical training or rotation in PC medicine during fellowship. While 90% of the responding fellows felt most comfortable with either writing dialysis orders in the chronic outpatient unit, seeing an ICU consult or writing continuous dialysis orders in the ICU, only 35% of them felt most comfortable "not offering" dialysis to a patient in the ICU with multi-organ failure. Nearly one out of five fellows surveyed felt obligated to offer dialysis to every patient regardless of benefit. Over two-thirds (67%) of the respondents thought that a formal rotation in PC medicine during fellowship would be helpful to them. To enhance clinical competency and confidence in PC medicine, a formal PC rotation during fellowship should be highly considered by nephrology training community.
Division of Kidney Diseases and Hypertension, Department of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra North Shore-LlJ School of Medicine , Great Neck, NY , USA and.
Update on end-of-life care training during nephrology fellowship: a cross-sectional national survey of fellows.
Combs SA, Culp S, Matlock DD, Kutner JS, Holley JL, Moss AH
Am J Kidney Dis. 2015;65(2):233. Epub 2014 Sep 20.
BACKGROUND: Patients with end-stage renal disease have high mortality and symptom burden. Past studies demonstrated that nephrologists do not feel prepared to care for their patients at the end of life. We sought to characterize current palliative and end-of-life care education received during nephrology fellowship and compare this with data from 2003.
STUDY DESIGN: Cross-sectional online survey of second-year nephrology trainees. Responses were compared to a similar survey in 2003.
SETTING&PARTICIPANTS: 104 US nephrology fellowship programs in 2013.
MEASUREMENTS: Quality of training in and attitudes toward end-of-life care and knowledge and preparedness to provide nephrology-specific end-of-life care.
RESULTS: Of 204 fellows included for analysis (response rate, 65%), significantly more thought it was moderately to very important to learn to provide care at end of life in 2013 compared to 2003 (95% vs 54%; P<0.001). Nearly all (99%) fellows in both surveys believed physicians have a responsibility to help patients at end of life. Ranking of teaching quality during fellowship in all areas (mean, 4.1±0.8 on a scale of 0-5 [0, poor; 5, excellent]) and specific to end-of-life care (mean, 2.4±1.1) was unchanged from 2003, but knowledge of the annual gross mortality rate for dialysis patients was nominally worse in 2013 because only 57% versus 67% in 2003 answered correctly (P=0.05). To an open-ended question asking what would most improve fellows' end-of-life care education, the most common response was a required palliative medicine rotation during fellowship.
LIMITATIONS: Assessments were based on fellows' subjective perceptions.
CONCLUSIONS: Nephrology fellows increasingly believe they should learn to provide end-of-life care during fellowship. However, perceptions about the quality of this teaching have not improved during the past decade. Palliative care training should be integrated into nephrology fellowship curricula.
Department of Medicine, University of Colorado School of Medicine, Aurora, CO. Electronic address: firstname.lastname@example.org.