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Medline ® Abstracts for References 4,9,21-24

of 'Palliative care: End-stage renal disease'

4
TI
Renal palliative care.
AU
Cohen LM, Moss AH, Weisbord SD, Germain MJ
SO
J Palliat Med. 2006;9(4):977.
 
Patients with chronic kidney disease have a shortened life expectancy and carry a high symptom burden. Clinicians need sophisticated expertise in pain and symptom management and skills in communication to meet the many needs of this population. This article reviews the literature and discusses prognosis, ethical and legal considerations, symptoms, treatment, and end-of-life issues. The field of nephrology is shifting from an exclusive focus on increasing survival to one that provides greater attention to quality of life. There is an opportunity to integrate many of the advances of palliative medicine into the comprehensive treatment of these patients.
AD
Renal Palliative Care Initiative, Baystate Medical Center, Springfield, Massachusetts 01199, USA. lewis.cohen@bhs.org
PMID
9
 
 
Renal Physicians Association Clinical Practice Guideline. Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis, 2nd ed, 2010.
 
no abstract available
21
TI
Palliative care/hospice and the withdrawal of dialysis.
AU
Neely KJ, Roxe DM
SO
J Palliat Med. 2000;3(1):57.
 
While the majority of end-stage renal disease (ESRD) patients on dialysis lead satisfying lives, an increasing number are choosing to withdraw from dialysis before death. A partnership between nephrology and palliative care/hospice healthcare teams would seem likely in the care of ESRD patients, yet this is often not the case. In anticipation of increasing participation by palliative care/hospice teams in the care of such patients, this article reviews the decision-making process of withdrawal and the medical care of the patient who withdraws. While withdrawal can be an acceptable choice from a medical, legal, psychiatric, and ethical point of view, it can nonetheless be complex. Profound decisions are often characterized by the need for time to process, and by ambivalence among patient, family and healthcare providers. In addition to caring for the patient and family, the palliative care/hospice team will want to consider the needs of the referring nephrology team as well. A "uremic death" is characterized as painless; however, other symptoms related to the accumulation of toxins and fluid can be anticipated and managed. Pharmacological intervention of uremic symptoms, as well as the pain attendant to other, nonrenal comorbid disease is accomplished with awareness of the impact of renal failure on the excretion of various drugs and their metabolites.
AD
Northwestern University Medical School, Division of General Internal Medicine, Chicago, Illinois 60611, USA. k-neely@nwu.edu
PMID
22
TI
End-of-life care preferences and needs: perceptions of patients with chronic kidney disease.
AU
Davison SN
SO
Clin J Am Soc Nephrol. 2010;5(2):195. Epub 2010 Jan 14.
 
BACKGROUND AND OBJECTIVES: Despite high mortality rates, surprisingly little research has been done to study chronic kidney disease (CKD) patients' preferences for end-of-life care. The objective of this study was to evaluate end-of-life care preferences of CKD patients to help identify gaps between current end-of-life care practice and patients' preferences and to help prioritize and guide future innovation in end-of-life care policy.
DESIGN, SETTING, PARTICIPANTS,&MEASUREMENTS: A total of 584 stage 4 and stage 5 CKD patients were surveyed as they presented to dialysis, transplantation, or predialysis clinics in a Canadian, university-based renal program between January and April 2008.
RESULTS: Participants reported relying on the nephrology staff for extensive end-of- life care needs not currently systematically integrated into their renal care, such as pain and symptom management, advance care planning, and psychosocial and spiritual support. Participants also had poor self-reported knowledge of palliative care options and of their illness trajectory. A total of 61% of patients regretted their decision to start dialysis. More patients wanted todie at home (36.1%) or in an inpatient hospice (28.8%) compared with in a hospital (27.4%). Less than 10% of patients reported having had a discussion about end-of-life care issues with their nephrologist in the past 12 months.
CONCLUSIONS: Current end-of-life clinical practices do not meet the needs of patients with advanced CKD.
AD
Department of Medicine, University of Alberta, Alberta, Canada. sara.davison@ualberta.ca
PMID
23
TI
Doc, don't procrastinate...Rehabilitate, palliate, and advocate.
AU
Jassal SV, Watson D
SO
Am J Kidney Dis. 2010;55(2):209.
 
AD
PMID
24
TI
Education and end of life in chronic kidney disease: disparities in black and white.
AU
Cukor D, Kimmel PL
SO
Clin J Am Soc Nephrol. 2010;5(2):163. Epub 2010 Jan 14.
 
AD
PMID