Advancing Palliative Care in Patients With CKD: From Ideas to Practice

BC Renal Palliative Care Committee

Research output: Contribution to journalArticlepeer-review

Abstract

A palliative approach to care focuses on what matters most to patients with life-limiting illness, including chronic kidney disease (CKD). Despite recent publication of related clinical practice guidelines in nephrology, there is limited information about how to practically implement these recommendations. In this Perspective, we describe our experience integrating a palliative approach within routine care of patients with CKD glomerular filtration rate categories 4 and 5 (G4-G5) across a provincial kidney care network during the past 15 years. The effort was led by a multidisciplinary group, tasked with building capacity and developing tools and resources for practical integration within a provincial network structure. We used an evidence-based framework that includes recommendations for 4 pillars of palliative care to guide our work: (1) patient identification, (2) advance care planning, (3) symptom assessment and management, and (4) caring of the dying patient and bereavement. Activities within each pillar have been iteratively implemented across all kidney care programs using existing committees and organizational structures. Key quality indicators were used to guide strategic planning and improvement. We supported culture change through the use of multiple strategies simultaneously. Altogether, we established and integrated palliative care activities into routine CKD G4-G5 care across the continuum from nondialysis to dialysis populations.

Original languageEnglish (US)
Pages (from-to)420-426
Number of pages7
JournalAmerican Journal of Kidney Diseases
Volume77
Issue number3
DOIs
StatePublished - Mar 2021
Externally publishedYes

Keywords

  • Advance care planning (ACP)
  • advanced CKD
  • chronic kidney disease (CKD)
  • dialysis
  • end-of-life (EOL)
  • end-stage renal disease (ESRD)
  • implementation science
  • life-limiting illness
  • palliative care
  • patient-centered care
  • supportive care
  • symptom management

ASJC Scopus subject areas

  • Nephrology

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