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Kidney Week

Abstract: TH-PO650

A Brief End-of-Life Screening Module Improves Knowledge About End-of-Life Desires in CKD Patients

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Bleyer, Anthony J., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Kim, Nathan, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Robey, Catherine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Sampath-Kumar, Revathy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Wang, Allison Elizabeth, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
Background

There are currently no published screening tools regarding end of life (EOL) care. An EOLmodule was developed and used by a nephrologist over the last decade. The module included three questions: 1) Whom would the patient like to make health care decisions in the event the patient is unable? 2) Is this the patient’s next of kin? 3) In case of a medical catastrophe that resulted in severe changes in health and mentation that would be highly unlikely to be reversible, the patient would/would not want to be kept alive by artificial means, including dialysis. The checklist in general requires approximately 5 minutes for completion.

Methods

A retrospective review was performed on 398 patients seen in the outpatient clinic by the nephrologist who used the EOLM over ten years and a control group of 299 patients seen by other nephrologists at the same clinic. The following data were collected from the electronic medical record: demographic data, information regarding EOL, patient comorbidities, and outcomes. All statistical analyses were conducted using SAS software.

Results

The EOLM was completed in 167 of 398 patients (42%) by the nephrologist using the EOLM. EOL was discussed in 17/299 (5.7%) patients seen by other nephrologists (p<0.0001). The mean age of patients using the EOLM was 63 years, 63% male, 55% with ESRD, 62% white, 31% African American. 89% of patients wanted comfort care in the event of a health catastrophe, with 6% desiring full care, and 5% undecided. 16 of 182 individuals (8.8%) identified an individual who was not their next of kin as the person that they would like to make healthcare decisions for them. 10/12 (83%) EOLM patients vs 19/37 (51%) control patients died during hospital admission and had documentation in the chart that EOL wishes were met (p=0.089).

Conclusion

An EOLM identified that the vast majority of CKD patients desire comfort care in the event of a health catastrophe. Nine percent of patients desired a surrogate decision maker who was not their next of kin and needed further documentation. Over ten years, only 12/167 patients died during a hospitalization. Patients with an EOLM were more likely to have EOL goals met (83% vs. 51%), though this was not significant due to lack of power.

Funding

  • Clinical Revenue Support