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Kidney Week

Abstract: PO1378

Evaluation of a Concurrent Hospice-Dialysis Program for Patients with ESRD

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • 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
  • Motter, Erica M., 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

Most dialysis patients are hospitalized in the last month of life, nearly half of whom receive intensive care. Hospice financing poses a major barrier to hospice delivery to dialysis patients, increasing inequities for high-quality end-of-life care. The Concurrent Hospice-Dialysis Program aims to promote timely hospice services for dialysis patients with limited prognosis by offering concurrent hospice and dialysis.

Methods

We conducted a mixed methods study comprised of chart reviews and semi-structured interviews with 10 bereaved caregivers of deceased patients who were enrolled in the Concurrent Hospice-Dialysis Program and 13 clinicians who provided care as part of the program.

Results

Four major themes were identified: 1) Decisional distress regarding stopping dialysis; 2) The option to continue dialysis served as a psychological bridge to hospice; 3) Clear referral process, formal patient education, and care coordination between hospice and dialysis teams facilitated successful implementation; 4) Providing hospice and dialysis promoted goal-concordant care at end-of-life.

Conclusion

Bereaved caregivers and clinicians involved with the Concurrent Hospice-Dialysis Program found the program broadly acceptable and recommended it for patients on dialysis interested in hospice services. They offered suggestions for systematizing and disseminating the program.

Table 1. Key Themes
ThemeRepresentative Quote
Decisional distress regarding dialysis cessation“The weight of stopping dialysis is so heavy that it takes so much time and planning and conversation to get a family [..] to see the benefit.”
Psychological bridge“Just knowing that it's an option […] alleviates a lot of the fear and the sense of abandonment that can come with these really tough decisions.”
Facilitator - care coordination“We communicate far in advance. We set things up […] so that we're prepared for what might happen. That is the best part of it.”
Overall impression“[…] it was really the best of all worlds.”
“I think the ones that have gone through this kind of program have done a lot better.”