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Abstract: PO1379

Concurrent Hospice Dialysis: Perspectives on Dissemination

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Motter, Erica M., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Robinson, Mayumi, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Ernecoff, Natalie C., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Lagnese, Keith, UPMC Family Hospice, Pittsburgh, Pennsylvania, United States
  • Taylor, Robert, Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Schell, Jane O., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
Background

In the United States, people receiving dialysis have traditionally been unable to enroll in hospice without ceasing dialysis treatments due to policy constraints. Therefore, these patients are often denied the full benefits of quality end-of-life care, either dying in hospitals or spending only a few days on hospice after dialysis is stopped. An alternative model would allow people living with end-stage renal disease (ESRD) to receive hospice services concurrently with dialysis treatments.

Methods

We implemented a concurrent hospice-dialysis program in one health system as proof of concept. In this project, we sought to build evidence for feasibility and program requirements for extending such programs to other settings across the country. We conducted semi-structured interviews with people living with ESRD, family caregivers, hospice and dialysis clinicians, and health system administrators from the Pittsburgh area and other regions in the U.S. Interviews elicited perceptions of strengths and weaknesses of a scalable concurrent hospice and dialysis program, including barriers and facilitators of implementation across various settings.

Results

We completed 25 interviews with 2 patients (8%), 3 caregivers (12%), 15 clinicians (60%), and 5 administrators (20%). Preliminary themes include important considerations: 1) Mechanisms and operational definitions for identification of eligible patients; 2) Procedures for decision-making conversations with patients and families; and 3) Protocols for communication between hospice and dialysis teams to coordinate care. Medicare policy and funding restrictions were also frequently discussed as barriers to the program.

Conclusion

Perspectives from patients, caregivers, clinicians and administrators describe critical implementation processes and resources for a successful concurrent hospice and dialysis program. These include the following: clear criteria for patient eligibility, consistent language to use when talking with patients and families, education for both hospice and dialysis teams, and a well-defined plan for care coordination between teams. Future evaluation of such programs may lead to policy change to make concurrent care broadly financially feasible.

Funding

  • Other NIH Support