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Abstract: SA-PO340

End-of-Life Care Planning Among Dialysis Patients: A Mixed-Methods Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Filus, Ania, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Harmeyer, Katie T., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States

Despite high mortality rate for older adults with end-stage kidney disease, little is known about the end-of-life (EoL) care needs and preferences among patients on chronic dialysis. In an effort to better understand patient comprehension of the EoL planning process and their preferences, we elicited insight from a cohort of dialysis patients using a mixed methods approach.


In step one we conducted semi-structured qualitative interviews with in-center dialysis patients in January-February 2021. The results from the qualitative part informed design of the online follow-up survey (step two). The online survey data was collected from in-center and home dialysis patients from August-September 2021.


In step one a total of 14 patients were interviewed. The average time on dialysis was 4.7 years. Results showed that patients had low understanding of EoL care terminology such as advance directive, health-care proxy, or hospice. Most patients reported that EoL conversations with their family members focused predominantly on practical issues related to dying (i.e., assets, burial) rather than EoL care (Figure 1). Common barriers to EoL care planning were: fear of death and belief that the best timing for EoL care planning are final months of one’s life. In step two, online survey data was collected from 796 patients. In the survey, a majority of patients reported that preparing and planning for their death was important to them. And 74% of patients reported that they gave some or a great deal of thought to their wishes about EoL care. Additionally, 64% of patients had discussed preferences with a family member, but only 22% discussed these with their doctor, social worker or nurse. Only 28% reported having completed a legal document that states their EoL preferences.


Dialysis patients have little awareness and understanding of steps involved in EoL care planning, and typically do not engage in EoL care conversations with their health care team. This study emphasizes the need for better patient education regarding the necessity of legal formalization of EoL preferences.