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Kidney Week

Abstract: FR-PO454

Palliative Care and Advance Care Planning Integration into the Dialysis Team: A Quality Improvement Intervention at a Hospital-Based Outpatient Hemodialysis Clinic

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Martin, Joanna Lynn, Jesse Brown VA Chicago Healthcare System, Chicago, Illinois, United States
  • Gmurczyk, Aleksandra, Jesse Brown VA Chicago Healthcare System, Chicago, Illinois, United States
  • Hauser, Joshua, Jesse Brown VA Chicago Healthcare System, Chicago, Illinois, United States
  • Varghese, Joanna Rachel, Jesse Brown VA Chicago Healthcare System, Chicago, Illinois, United States
  • Ozersky, Julie, Jesse Brown VA Chicago Healthcare System, Chicago, Illinois, United States
  • Oliver, Tyra D., Jesse Brown VA Chicago Healthcare System, Chicago, Illinois, United States
  • Fischer, Michael J., Jesse Brown VA Chicago Healthcare System, Chicago, Illinois, United States
Background

Despite substantial symptom burden and high mortality, adults receiving maintenance hemodialysis (HD) infrequently utilize palliative care (PC). With mostly hospital-based outpatient dialysis clinics, Veterans Affairs (VA) is well-positioned to increase access to PC services. At a large urban VA dialysis unit, we initiated a year-long intervention to improve Life Sustaining Treatment (LST) note and advance care planning (ACP) completion.

Methods

A PC physician was integrated into the dialysis care team at the Jesse Brown VA (JBVA) Medical Center to improve LST and advance directive (AD) completion. The PC physician worked with the dialysis team to provide palliative education and refine and bolster approaches to ACP. The PC physician contacted all patients needing an AD or LST note. After 12 months, we reassessed percentages of patients with LST and AD completion. Change in proportion with note completion pre/post PC intervention was compared.

Results

Among all outpatient HD patients at the JBVA, the average age was 71 years, 85% were Black, 99% were male, and the average time on HD was 4.7 years. Frequent consultation with the dialysis social worker was essential to targeting patients for the intervention. Most patients preferred private phone calls with the PC physician to discuss ACP. Integration of a PC physician into the dialysis care team significantly increased patient completion of an AD and LST note as noted in table.

Conclusion

Integrating a PC physician into the dialysis care team led to a substantial increase in LST and advance directives for maintenance HD patients. Future PC integration plans should build on these gains in advance care planning, measure their impact on subsequent care and also extend to alleviating symptom burden.

 May 2022 (pre-PC intervention)April 2023 (post-PC intervention)p-value
Number of Dialysis Clinic Patients5970 
Patients with VA Advance Directive38 (64%)62 (89%)<0.01
Patients with LST note53 (90%)70 (100%)<0.01