Dedicated to End-of-Life Care for Kidney Patients
Mission:
To promote effective interchange between patients, families,
caregivers, payers, and providers in support of integrated patient-centered
end-of-life care of chronic kidney disease (CKD) patients.
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Physician
Education
End-of-life care is best provided
by an interdisciplinary team, but nephrologists play a unique
role on this team. This role was highlighted in the Renal
Physicians Association (RPA)/American Society of Nephrology
(ASN) Clinical Practice Guideline, Shared
Decision-Making in the Appropriate Initiation of and Withdrawal
from Dialysis. The guideline noted that nephrologists
participate in decision-making with their patients and estimate
prognosis. Based on an understanding of the patient’s
values and prognosis, nephrologists may recommend that dialysis
be withheld or withdrawn. They are the ones to institute a
palliative care approach to the end-of-life care of the dialysis
patient and to refer to hospice when appropriate. There has
also been recent recognition of the high prevalence of pain
in dialysis patients near the end of life and the function
pain plays in detracting from the quality of life of dialysis
patients. Nephrologists improve their patients’ quality
of life by assessing and managing pain and other symptoms
with the same attention and detail they provide for vascular
access, anemia, dialysis adequacy, and bone disease. The Physician
Education workgroup will develop educational tools for nephrologists
to assist them with communication and decision-making with
patients and families at the end of life.
The Robert Wood Johnson Foundation's
Promoting
Excellence: End-Stage Renal Disease Workgroup Recommendations
to the Field report describes the need for palliative
care in the ESRD population and presents the methods, findings,
recommendations, and products of the Promoting Excellence
ESRD Workgroup.
Assessing
Decision-Making Capacity Alvin Moss, M.D., from The Center
for Health Ethics and Law, Robert C. Byrd Health Sciences
Center, at West Virginia University, offers instructions on
how to assess a patient’s decision-making capacity.
Core
Curriculum on Palliative Care for Nephrologists, American
Journal of Kidney Diseases, 43.1 (Jan 2004): 172-185.
Written by Alvin H. Moss, MD, Jean L. Holley, MD, Sara N.
Davison, MD, Richard A. Dart, MD, Michael J. Germain, MD,
Lewis Cohen, MD, and Richard D. Swartz, MD.
Recommendations
to Dialysis Units for Addressing End-of-Life Care in ESRD
- eight (8) areas that each dialysis facility should consider
in offering palliative care to their patients.
RPA
and ASN Position Statement on Quality Care at the End
of Life
27 Frequently
asked questions and answers about end-of-life care for
renal patients.
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