RENAL SUPPORTIVE CARE: CURRENT EXPERIENCES IN VICTORIA

K DUCHARLET1, J PHILIP2,3, J WEIL2, N BARRACLOUGH4, C SOMERVILLE5, P MCCLELLAND6, J BEAVIS7, H GOCK1,3

1Department of Nephrology, St Vincent’s Hospital, Melbourne, Victoria; 2Palliative Service, St Vincent’s Hospital, Melbourne, Victoria; 3Department of Medicine, Melbourne University, Melbourne, Victoria; 4 Department of Medicine, South West Healthcare, Warrnambool, Victoria; 5Department of Nephrology, Barwon Health, Geelong, Victoria; 6Department of Medicine, Goulburn Valley Health, Shepparton, Victoria; 7Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria

Background: Patients with advanced Chronic Kidney Disease (CKD) have a high burden of physical and psychosocial morbidity, frequently associated with frailty and limited prognosis.  Renal Supportive Care (RSC) is increasingly recognised as a valid non-dialysis, non-transplantation pathway for many of these patients.  However, understanding the role, timing and application of RSC amongst healthcare providers is not known.

Aim: To explore current attitudes and experiences of RSC and Palliative Care by renal clinicians.

Methods: An exploratory qualitative study was conducted across 5 Victorian hospitals. Focus groups and semi-structured interviews of renal clinicians were audio recorded and transcribed for thematic analysis by two independent researchers.

Results: Of participants recruited (n=58), there were 35 nurses (3 practitioners, 2 educators, 5 ward, 25 dialysis) and 23 doctors (5 nephrology trainees, 18 nephrologists). Clinical experience ranged from 0.5-40 years.

Four major themes emerged on preliminary analysis:

1) Perceptions and practices of RSC vary substantially. However, RSC is perceived more acceptable for patients than Palliative Care.

2) Compared with dialysis, non-dialysis patients have a poorly defined pathway of care that is not well resourced.

3) Both dialysis and non-dialysis CKD patients have few, readily identified transition points to herald the final phase-of-life.  Therefore, its recognition is inconsistent.

4) At end-of-life, patients, families and treating teams frequently have differing views on active management, continuation of life-supporting therapy and only providing comfort measures.

Conclusions: The perception and understanding of RSC varies widely.  RSC may improve care for some patients but a consistent approach is lacking. There is a need for a consensus RSC pathway and resources may be required for service development and health service integration.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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