DI CLAYTON-CHUBB1, A MCLEAN1, L PAPADOPOULOS1, L COLQUHOUN1, M FRAENKEL1
1Department of Renal Medicine, Eastern Health, Victoria, Australia
Aim: To ascertain the rates of Advanced Care Planning (ACP) – either formally or informally – in end-stage kidney disease (ESKD) patients on haemodialysis and those managed supportively without dialysis.
Background: ACP is a process where patients are supported through making plans for their future care and end of life. They involve both the medically practical and the spiritual/religious/environmental. ESKD patients are in the unique position of having frequent contact with healthcare providers, thus having more opportunities to develop ACPs. Initial conversations around renal replacement therapy versus supportive care lend themselves to this; however, in our practice and generally, few patients have formal ACPs.
Methods: Mortality data was collected retrospectively over 13 months from March 2015 to March 2016 for patients with Stage 5 Chronic Kidney Disease known to Eastern Health renal outpatients who were either on haemodialysis or managed supportively. Demographic data was collected via electronic medical records, and outpatient notes/letters were reviewed. Formal ACP Program documentation was noted.
Results: 54 patients meeting inclusion criteria died in our study period (mean age at death 77.0 years). 30 (55.6%) were offered formal ACPs or had informal ACPs documented. 37 (68.5%) were haemodialysis patients (mean duration >37.0 months), and 17 (31.5%) were conservatively managed. 10 were referred to the ACP team; 3 had ACPs in place (all 3 were supportive care patients). 28 (51.9%) died in acute hospitals, 10 (18.5%) in palliative care facilities and 7 (13.0%) at home/nursing home (with the remainder undocumented).
Conclusions: Despite frequent access to healthcare providers, no haemodialysis and few supportively managed ESKD patients had formal ACPs in place. However, over half were offered formal ACPs or had informal ACPs documented.