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Medline ® Abstract for Reference 123

of 'Psychosocial issues in advanced illness'

End-of-life care preferences and needs: perceptions of patients with chronic kidney disease.
Davison SN
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.
Department of Medicine, University of Alberta, Alberta, Canada. sara.davison@ualberta.ca