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Abstract: PO1376

Nurse-Driven Advance Care Planning in a Hemodialysis Unit in a Veteran Population

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Tonthat, Sam, University of California Irvine, Orange, California, United States
  • Yamarik, Rebecca, Long Beach Veteran Affairs Healthcare System, Long Beach, California, United States
  • Fernandez, Jocell, Long Beach Veteran Affairs Healthcare System, Long Beach, California, United States
  • Ballard-Hernandez, Jennifer, Long Beach Veteran Affairs Healthcare System, Long Beach, California, United States
  • Cacciata, Marysol, Long Beach Veteran Affairs Healthcare System, Long Beach, California, United States
  • Gupta, Pankaj, Long Beach Veteran Affairs Healthcare System, Long Beach, California, United States
  • Chen, Joline L.T., Long Beach Veteran Affairs Healthcare System, Long Beach, California, United States
Background

Patients with end-stage kidney disease (ESKD) face difficult choices near the end of life. Advance care planning (ACP) allows patients and their providers to plan for treatments that align with patients' goals. In the US, only 6-35% of all ESKD patients have advance directives (AD). PREPARE is an interactive ACP website that helps patients complete AD and express their wishes regarding medical decisions. The goal of the study is to assess the feasibility and acceptability of using a nurse to facilitate ESKD patients to completing the PREPARE ACP during dialysis.

Methods

Inclusion criteria include patients without a documented AD within the past 3 years. Exclusion criteria are dementia/cognitive impairment, psychosis, deafness, or blindness. Pre and post engagement surveys were completed. Barriers related to navigating the PREPARE website were documented.

Results

Of 55 patients at the dialysis unit, 25 were eligible and 14 were enrolled . All participants are male with mean age of 69. All participants completed their AD within 1 dialysis treatment. In the pre-PREPARE questionnaire, using the Likert scale of 1 to 5 (1 for “not at all” to 5 for “extremely likely”), patients reported a mean score of 4.07 for readiness to talk about end-of-life care to a close family/friend, 4.23 for readiness to talk to a care provider, 4.46 for readiness to express wishes in writing, and 4.61 for readiness to sign official documentation. In the Post-PREPARE questionnaire, on a scale of 1 (very hard) to 10 (extremely easy), patients scored 7.61 for ease, 7.23 for comfortability, and 8.07 for helpfulness. Analysis of PREPARE AD showed that on a scale of 1 (AD goal mainly to extend life) to 5 (focus on the quality of life), the mean score is 3.06 suggesting that patients value both “extend life” and “maintain quality of life”. Five patients expressed wishes for full care, 6 wanted a trial of resuscitation, and 3 requested DNR. Barriers to using PREPARE included patient difficulty navigating the website without help and using a laptop during dialysis when both hands are not always free.

Conclusion

Our study shows that PREPARE is a feasible method in facilitating ACP during dialysis, however, many patients needed assistance to complete the process. Future studies are needed to apply PREPARE and ACP wishes in the ESKD population.

Funding

  • Private Foundation Support