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Kidney Week

Abstract: PO1700

Feasibility and Acceptability of Telepalliative Care in Rural Dialysis Units

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Cheung, Katharine L., University of Vermont College of Medicine, Burlington, Vermont, United States
  • Kurella Tamura, Manjula, Stanford University School of Medicine, Stanford, California, United States
  • Lamantia, Michael A., University of Vermont College of Medicine, Burlington, Vermont, United States
  • Rabinowitz, Terry, University of Vermont College of Medicine, Burlington, Vermont, United States
  • Stapleton, Renee, University of Vermont College of Medicine, Burlington, Vermont, United States
  • Gramling, Bob, University of Vermont College of Medicine, Burlington, Vermont, United States
Background

Limited access to palliative care is a key barrier to its integration in routine dialysis care. We evaluated the feasibility and acceptability of telepalliative care while patients received dialysis in rural units.

Methods

The target population included any patients with end-stage kidney disease receiving dialysis. Palliative care physicians and APPs conducted consultations as per their usual practice and used a large wall mounted screen with centrally posititioned camera. Patients used an iPad attached to an IV pole positioned next to the dialysis chair. Patients were provided the option of having family present, receiving the consult on dialysis or off dialysis in a private room. Feasibility was measured by 1-month completion rate. Acceptability was measured using an adapted telemedicine questionnaire.

Results

We recruited 40 patients to undergo a telepalliative care consultation while receiving dialysis. Four specialty palliative care clinicians (3 physicians and 1 nurse practitioner) conducted the visits. The recruitment rate was 35% (40/113), scheduling rate was 97.5% (39/40) and completion rate was 85% (33/39). Thirty-six patient participants (15 women, 21 men) completed the baseline survey. One patient requested family to be present during the conversation. No patients requested to have the conversation off dialysis in a private room. Audiovisual aspects of the conversation were rated highly. More than 3/4 reported the visit being at least as good as an in-person visit and 40% felt the televisit was better. Patients felt the appointment was relevant to them, but they were less certain that they learned new things about their condition, and they were mixed about whether the appointment changed the way they think about dialysis.

Conclusion

Telepalliative care is acceptable to patients receiving dialysis and is a feasible approach to integrating palliative care in rural dialysis units.

Acceptability of Telepalliative care in dialysis
Acceptability score, (LIkert score 1-5, 1- strongly agree/very helpful)1.75 
Telepalliative was better than in-person visit41% 
Telepalliative was no better or worse than in-person38% 
Telepalliative was worse than in-person visit21% 
Requested to meet again with palliative careYes56%
 Maybe34%
 No9%

Funding

  • Private Foundation Support