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Kidney Week

Abstract: TH-PO645

Redefining End-of-Life Care in Dialysis: A Concurrent Hospice and Dialysis Program for Terminal Dialysis 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

  • Schell, Jane O., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Lagnese, Keith, Family Hospice & Palliative Care, Pittsburgh, Pennsylvania, United States
  • Taylor, Robert, DCi incorporated, Nashville, Tennessee, United States
Background

End of life for patients with end stage kidney disease (ESRD) is defined by increased health care utilization with limited access to hospice services. Financial and regulatory barriers within the Hospice Medicare Benefit often require patients to stop dialysis to receive hospice services. Unsurprisingly 40% of dialysis patients on hospice receive these services for three or less days. We developed a concurrent hospice and dialysis program with the goal to increase hospice utilization and improve patient, family and provider experience.

Methods

The ESRD Concurrent Care Program is a quality improvement initiative developed through partnership between Dialysis Clinic, Inc.’s Independence ESCO and UPMC Family Hospice in Pittsburgh, PA. The program offers concurrent hospice and palliative dialysis (10 sessions with weekly assessment) to terminal dialysis patients with an expected prognosis of two months or less and whose goals are comfort-focused. Palliative dialysis includes adjustment in the timing, frequency and delivery of dialysis to address symptoms and end of life goals. Outcomes measured include hospice length of stay (LOS), number of dialysis treatments provided and place of death.

Results

Since the program was initiated in January, 2018, 10 patients were offered the concurrent program. One patient elected to stop dialysis at enrollment. Of the remaining nine patients who elected the concurrent program, six survived to receive planned dialysis session(s). Among these six patients, 50% were female and all but one was Caucasian. Five of six patients received hemodialysis, and one patient received peritoneal dialysis. Hospice length of stay was almost 2 weeks (13.8 days, range of 7 to 28 days). The average number of dialysis treatments was 3.3 (range of 1 to 8 treatments). All patients died in a home-like environment. End of life goals attained included attending planned celebrations, spending time with family, and acheiving a sense of control.

Conclusion

Our concurrent hospice and dialysis program led to longer hospice LOS compared to general care trends. By allowing up to ten additional treatments, patients and families were able to achieve their end of life goals. Future direction involves expansion of the program within DCI with the goal to inform policy change in hospice delivery for dialysis patients at end of life.