Abstract: TH-PO791
Palliative Care for Patients With Failing Kidney Allograft: A Mixed Methods Study
Session Information
- Voices, Choices, and Outcomes of Older Adults with CKD
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1200 Geriatric Nephrology
Authors
- Reich, Amanda Jane, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Murakami, Naoka, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Lakin, Joshua R., Dana-Farber Cancer Institute, Boston, Massachusetts, United States
- He, Katherine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Gelfand, Samantha L., Brigham and Women's Hospital, Boston, Massachusetts, United States
- Leiter, Richard E., Dana-Farber Cancer Institute, Boston, Massachusetts, United States
- Adler, Joel Thomas, The University of Texas at Austin, Austin, Texas, United States
- Lu, Emily, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Ong, Song Ching, The University of Alabama at Birmingham Montgomery, Montgomery, Alabama, United States
- Concepcion, Beatrice P., Vanderbilt University, Nashville, Tennessee, United States
- Singh, Neeraj, Willis-Knighton Health System, Shreveport, Louisiana, United States
- Murad, Haris Farooq, Washington University in St Louis, St Louis, Missouri, United States
- Anand, Prince Mohan, Medical University of South Carolina, Charleston, South Carolina, United States
- Ramer, Sarah, James J Peters VA Medical Center, New York, New York, United States
- Dadhania, Darshana M., Weill Cornell Medicine, New York, New York, United States
- Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States
- Alhamad, Tarek, Washington University in St Louis, St Louis, Missouri, United States
Group or Team Name
- KRAFT workgroup
Background
Patients with failing kidney allografts suffer from multiple co-morbidities and experience significant symptom burden. Palliative care (PC) in transplant recipients is underutilized and the underlying barriers to PC delivery to renal transplant patients are poorly characterized.
Methods
We conducted an explanatory sequential mixed methods study with an online survey followed by semi-structured interviews targeting US transplant clinicians.
Results
A total of 149 participants (83 nephrologists, 31 nurses, 15 advanced practice providers, 10 surgeons, 6 social workers, 4 others) from 80 transplant centers completed the survey, of which 19 completed an interview. Most transplant clinicians (68%) have never or rarely referred transplant patients to PC. Participants reported poor patient functional status (86%), cancer diagnosis (76%) and frailty (74%) as the most influential factors for PC referral. Regarding timing of PC referral, most providers disagreed with PC involvement in pre-transplant (68%) or early post-transplant (74%) phases. Some (41%) thought that the goals of transplantation and PC are contradictory, others (60%) agreed with consulting PC only near end-of-life, but 62% also thought that early PC intervention may be beneficial in persistent allograft dysfunction. Barriers to engaging PC included patient/caregivers’ unrealistic prognostic expectations (69%) and competing demands for clinicians’ time (43%). Interviews revealed institution-level (e.g. narrow PC service scope, overburdened PC services) and clinician-level factors (e.g. lack of relationship between PC and transplant teams, limited understanding of patients’ racial, ethnic or cultural background) that lead to the patterns observed in our survey. Additionally, interviews suggested several facilitators to PC care referral: improving awareness of PC services and educations to clinicians and patients/caregivers.
Conclusion
This mixed methods study highlights opportunities to improve the engagement of PC for transplant recipients. More attention is needed to optimize the timing, clinical setting and collaborative model to best deliver PC, especially for the diverse populations served by renal transplant teams.
Funding
- Private Foundation Support