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Kidney Week

Abstract: TH-PO894

Nationwide Implementation of Integrated Renal Palliative Care: A Model for Middle-Income Countries

Session Information

Category: CKD (Non-Dialysis)

  • 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention


  • Abdullah, Rafidah, Hospital Putrajaya Malaysia, Putrajaya, Selangor, Malaysia

Malaysia is an upper-middle-income country and is categorized as having isolated provisions for palliative care services (Stage 3A). End-stage kidney disease (ESKD) patients have reported palliative care symptoms and their needs are largely unmet. Integration of palliative care into nephrology services will increase access to renal patients.


Comparisons between Malaysia, a middle-income country with a high-income country, United Kingdom were made using Checkland's CATWOE and needs assessment (comparative and corporate approaches). Analysis of current renal services was performed using SWOT analysis.


A model of healthcare delivery using four components was designed - structure, process, output, and outcome (Image 1) based on SWOT analysis. The emphasis was put on engagement, capacity, and environmental aspects; in accordance with the findings of the comparative needs assessment. National Palliative Care policy and strategic plan 2019-2030 for Malaysia strongly supported the integration of services. Following this, the integration of renal palliative care into nephrology services was identified as key for nephrology services, a forefront for the 12th National Strategic Plan for Malaysia 2021-2025. A framework for nationwide implementation was designed in four phases. In phase I, the foundation was laid in terms of training, questionnaire, planning, and multi-sectoral engagement. Phase II involved the development of shared decision-making including pre-dialysis education program and training. Phase III includes national implementation, training, audit, and quality improvements. In phase IV, there will be integration with primary care delivering community renal palliative care.


A standardized comprehensive ESKD care program will provide holistic healthcare delivery and access to achieve universal health coverage. This framework can be replicated and may be applicable to other middle-income countries. This implementation will achieve advanced integration of palliative care within nephrology services.