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Abstract: TH-PO592

Evaluation of Provincial Initiatives in Integrated Renal Palliative Care: A Baseline Assessment of Pre-Implementation Clinician Practices

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Hemmett, Juliya, BC Renal, Vancouver, British Columbia, Canada
  • Wang, Alice, UBC, Richmond, British Columbia, Canada
  • Thomas, Sarah Anne, BC Renal, Vancouver, British Columbia, Canada
  • Saunders, Sushila, BC Renal, Vancouver, British Columbia, Canada
  • Levin, Adeera, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
  • Hargrove, Gaylene M., Island Health, Victoria, British Columbia, Canada
Background

Early goals of care (GOC) conversations show improved patient outcomes, enhanced quality of life, and reduced health care costs. However, content and consistency of these end of life discussions have been variable. Based on a recent needs assessment from renal care providers, BC Renal has implemented a multipronged approach to improve palliative care in nephrology. This large-scale project requires systematic evaluation to demonstrate efficacy as part of ongoing quality improvement. Our objective was to assess baseline quantity and quality of GOC directives and discussions documentation in patients with advanced renal disease across 5 health authorities in British Columbia (BC).

Methods

This study has a one year duration, and includes all renal units in health authorities across BC. Interventions include: 1)Serious illness conversation guide (SICG) workshops at regional meetings and implementation of a “train the trainer” SICG program, 2)Online best practice guidelines to GOC and renal disease symptom management, and 3)Online patient resources. A pre-implementation chart audit was conducted on 30 randomly selected charts from CKD and dialysis clinics. The contents of the chart audit included: 1) Presence and location of GOC directive and GOC discussion, 2) Correlation between chart data and provincial renal database (PROMIS), and 3)Evaluation of GOC as per the SICG framework.

Results

The chart audit showed the majority of patients had GOC directives documented (80%), most within the last year (57.6%). GOC discussions were less commonly documented (47%); wide variability across health authorities (0-100%) existed. Documentation regarding GOC was sparse in PROMIS (23%). Prognosis and patients’ level of understanding was frequently documented during GOC discussions (92.3% & 69%), patients’ goals and involvement of family was less frequent (53% & 46%).

Conclusion

Our pre-implementation baseline assessment informs that room for improvement in the quantity of GOC discussions as well as consistency in documentation across health authorities and in PROMIS exists. Documenting family involvement and patient goals can be improved. This baseline data will guide further quality improvement initiatives.