K DUCHARLET1,2, J PHILIP1, H GOCK1,2
1St Vincent’s Hospital Melbourne, Fitzroy, Australia, 2Melbourne University, Parkville, Australia
Aim: To understand renal clinicians’ views and experiences of Renal Supportive Care (RSC) and Specialist Palliative Care (SPC).
Background: Patients with end stage kidney disease (ESKD) report high symptom burden, complex care needs and have a limited prognosis. RSC is an evolving clinical approach integrated within existing renal services aiming to improve quality of life (QOL). Clinicians’ perceptions of RSC and its role alongside that of SPC are unknown.
Methods: A cross-sectional validated online survey was undertaken between February and May 2018. Participants completed demographic details, views on RSC and SPC and elements of an “ideal model of RSC.”
Results: Of the 356 clinicians completing the survey, 78% were female, 59% nurses, 29% doctors, 69% metropolitan, 81% had SPC access, 59% RSC access with variability in reported activities of current RSC services. RSC was seen as improving symptoms and QOL (90%), different to SPC (78%), a more acceptable term than palliative care (80%).Participants suggested ideal RSC should include;
- symptom management (98%),
- improved integration between nephrology and community healthcare services (97%) and community SPC (93%),
- improved clinician RSC education (94%),
- RSC coordinator (91%),
- complex treatment decision making (90%),
- defined pathway for conservative patients (86%).
Clinicians were more likely to consider referral to RSC over SPC for symptoms, (85%vs78%,p=0.013), withdrawal from dialysis (94%vs87%,p=0.001), complex treatment decision making (84%vs59%,p=0.000), but SPC was favoured if the patient was dying (76%vs96%,p=0.000).
Conclusions:RSC is viewed as highly acceptable with a role in improving symptoms and QOL for renal patients. Widespread variation of current experience and access exists. This study revealed opportunities to improve new and existing services to assist ESKD patients.
Kathryn is a Nephrologist and PhD candidate with active clinical and research interests in CKD, Renal Supportive Care and Palliative Care.