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.