K DUCHARLET 1, H GOCK 1,2, Philip1,2
1St Vincent’s Hospital, Melbourne, Australia, 2University of Melbourne, Parkville, Australia
Background: Renal clinicians’ experiences of transitioning patients from active life prolonging care to end of life (EOLC) care is largely undocumented.
Aim: To explore experiences of EOLC for renal clinicians (doctors and nurses) to guide development of renal supportive care (RSC) services.
Methods: A sequential mixed methods study was undertaken. (1) A qualitative study of 53 Victorian renal clinicians to understand experiences of EOLC and RSC, (2) An online survey of 382 renal clinicians’ experiences across Australia and New Zealand to distil themes and priorities for RSC services, (3) A multidisciplinary advisory group examined findings from (1), and (2), and provided recommendations for RSC services in Victoria.
Results: When describing EOLC experiences, renal clinicians valued their commitment to continue caring for patients, clinical leadership and patient choice in decision making. The most difficult EOLC experiences were reported when one of these values were threatened or compromised. Renal doctors and nurses described acceptance and value of RSC services and earlier palliative care involvement especially for symptom control. However, variation in definitions, clinical scopes, and resourcing was associated with inconsistent care within and between health services.
The RSC advisory group recommended a consensus definition of RSC, an ideal RSC model and dedicated resources for data collection and collaboration across services to develop RSC services and improve EOLC experiences for patients and clinicians.
Conclusions: EOLC was challenging for renal clinicians if experiences were not consistent with professional values. RSC was viewed as acceptable but widely variable in practice. RSC requires a systematic approach to definition, clinical scope, and outcome measurement to support renal clinicians with EOLC.
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