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Kidney Week

Abstract: FR-PO321

Location and Preference for Place of Death in Those Supported by a Kidney Supportive Care Clinic

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Jahan, Sadia, Metro North Hospital and Health Service, South Brisbane, Queensland, Australia
  • Purtell, Louise, Queensland University of Technology, Brisbane, New South Wales, Australia
  • Bonner, Ann, Queensland University of Technology, Brisbane, New South Wales, Australia
  • Healy, Helen G., Metro North Hospital and Health Service, South Brisbane, Queensland, Australia
  • Rawlings, Cassandra, Metro North Hospital and Health Service, South Brisbane, Queensland, Australia
Background

Kidney supportive care (KSC) multidisciplinary clinics aim to improve quality of life and respect a person’s wishes in death. One important outcome indicator of meeting a person’s wishes is place of death (POD). The literature reports patients’ preferred POD is most frequently their home or palliative care unit. Despite this body of literature, 54% of deaths in those aged over 65 occur in hospitals and 14% at home in Australia.

We aim to assess if POD is concordant with actual POD in those known to KSC clinic.

Methods

Retrospective cohort study of patients attending a single center KSC clinic from February 2016 and who died prior to April 2019. Data including demographics, kidney replacement therapy pathway, prefered POD, actual POD, details of hospital deaths, timing of KSC clinic review were extracted from medical records. Early referal was defined as being seen in an out-patient setting and late referral defined as those not seen until the terminal hospital admission. Late and early group POD were compared using a Chi-Square test.

Results

141 people were included in the analysis with the median age at death of 77 years (range 29-92 years), 40.4% female. Treatment pathways prior to death were haemodialysis (45.4%), peritoneal dialysis (6.4%) and conservative (48.2%). Referrals to KSC were early (73%) or late (27%). If seen early the preference for POD was in the community (80.6%; home or palliative care unit), hospital (9.7%) or it was unknown (9.7%). The preferred POD in those referred late was unknown (47.4%), community (36.8%) or hospital (15.8%). The early referral group were more likely to preference a community POD compared to late referrals (p=0.03). Concordance between preferred POD and actual POD in the early referral group was positive (63.1%), discordant (27.2%) or unknown (9.7%). Concordance in the late referral group was positive (31.6%), discordant (21%) or unknown (47.4%). The rate of concordance between groups was not statistically different.

Conclusion

Timely referral to a KSC clinic can assist with ensuring that death occurs in the preferred location. Late referrals do not allow adequate time for ascertaining or facilitating wishes. Ways to maximise quality of life and avoid medically futility need to be considered in this population.