Promoting Goals of Care Conversations in Older Veterans Referred for Dialysis Education: A Quality Improvement Study
- Geriatric Nephrology
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
- Zghayer, Aseel, Edward Hines Junior VA Hospital, Hines, Illinois, United States
- Schneider, Julia, Edward Hines Junior VA Hospital, Hines, Illinois, United States
- Vahlkamp, Alexi, Edward Hines Junior VA Hospital, Hines, Illinois, United States
- Limaye, Seema S., Edward Hines Junior VA Hospital, Hines, Illinois, United States
Elderly patients that progress to end stage kidney disease (ESKD) have multi-morbidity and higher mortality rates than others of similar age. The Veterans Affairs Life Sustaining Treatment Initiative (LSTI) promotes goals of care conversations in high-risk veterans to identify preferences for life sustaining treatments (LSTs). Life-sustaining treatment preferences are then documented in a LST note.
This quality improvement project created a palliative care (PC) consult trigger process for all ESKD Veterans 70 and older who were referred for dialysis modality education between 9/2022 –4/2023. The goal was to increase rates of LST note completion prior to dialysis initiation.
Twenty Veterans were referred for dialysis education in the six-month period. Sixteen of the 20 Veterans met age criteria for a PC trigger consult, characteristics are shown in table 1. Thirteen veterans attended the PC consult, one did not attend, and two declined. Only three veterans had LST notes completed prior to their referral for dialysis education. All Veterans who met with PC completed LST notes. One of 16 veterans opted for conservative treatment, and three initiated dialysis. Outcomes are shown in Table 2.
Trigger PC consultation at time of dialysis education in older patients led to 100 percent LST note completion rate. Including PC prior to dialysis initiation clarifies and documents preferences for LSTs. Future studies should examine the impact of PC consultation on the clinical course and quality of life in older ESKD Veterans.