Abstract: TH-PO591
Evaluation of Provincial Initiatives in Integrated Renal Palliative Care: A Baseline Assessment of Pre-Implementation Patient Perspectives
Session Information
- Health Maintenance, Nutrition, Metabolism - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1300 Health Maintenance, Nutrition, and Metabolism
Authors
- 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
- Hemmett, Juliya, BC Renal, Vancouver, British Columbia, Canada
Background
Early goals of care (GOC) conversations show improved patient outcomes and reduced health care costs. However, content and timing of these conversations have been variable. BC Renal has recently implemented a province-wide multipronged approach to improve palliative care in nephrology, which requires systematic evaluation to demonstrate efficacy as part of ongoing quality improvement. Patient perspectives are presented here as part of a larger evaluation framework. Our objectives were to assess baseline advanced directives experiences and perspectives in patients with advanced renal disease (CKD, peritoneal dialysis, home hemodialysis and in-center HD) across 5 health authorities in British Columbia (BC).
Methods
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. Pre-implementation telephone interviews (~15 minutes each) were conducted with 30 randomly selected patients across BC. Interviews were analyzed quantitatively for patients’ involvement in GOC and qualitatively for common themes. Following baseline assessment, a 1 year follow up across all jurisdictions in BC will be undertaken to evaluate improvements to the palliative care approach.
Results
67% of patients interviewed have advanced directives and living wills; this is more common in patients on dialysis (75%) than in patients with CKD (50%). Only 30% of patients had detailed discussions with their health providers about life-sustaining therapy or palliation in case of a life-threatening condition; this varied across health authorities. While most patients did not find GOC discussions to be difficult, they would prefer if providers initiated discussion at multiple time points and had more time to provide information.
Conclusion
This baseline patient perspective assessment informs strategies for improvement in the quality, quantity, timing and frequency of GOC discussions. The provincial integrated palliative nephrology initiative targeting these identified gaps in care will be evaluated in 1 year as part of a holistic evaluation framework.