Commitment to Practice Change Through Case-Based Learning to Improve Palliative Care for Older Patients with Kidney Failure
- 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
- Moss, Alvin H., West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
- Lupu, Dale, The George Washington University School of Nursing, Ashburn, Virginia, United States
- Corbett, Christine Marie, University Health Truman Medical Center, Kansas City, Missouri, United States
- Silberzweig, Jeffrey I., Rogosin Institute, New York, New York, United States
Patients with advanced chronic kidney disease (CKD) and kidney failure have many unmet palliative care needs. Nephrologist buy-in to implement primary palliative care has been cited as a major barrier. Interventions are needed to increase nephrologist awareness of and commitment to palliative care for their patients.
In a New York City-based CKD and dialysis program, we held a year-long series of monthly Project ECHO-style webinars. CKD and dialysis center staff screened patients for appropriateness for palliative care referral, agreed on pertinent patient issues, and presented their cases to an interdisciplinary expert faculty with backgrounds in nephrology, palliative medicine, and psychology. Participants evaluated webinars for practice relevance, whether they motivated them for practice change, and if so, in what way. Faculty categorized the major issue raised by each case. The online registration tool recorded the number and disciplines of participants.
By discipline, 65 clinicians participated one or more times including nephrologists. nurses, social workers, a psychologist, and palliative medicine physicians. On a scale from 1-5 (low to high relevance), participants rated information from webinars that could be applied to practice a mean of 4.9. Based on webinar content, 95% reported they were planning to make one or more changes to their practice, most commonly involving other team members in decision process (53%) and changing how often they raise palliative care topics (48%). Major issues raised by cases included whether to start frail nonagenarians with comorbidities on dialysis and how to manage the following issues in in-center hemodialysis patients: failing to thrive, dementia-related aberrant behavior, and substance use disorder. Knowledge exchange between nephrology and palliative medicine clinicians was reciprocal and fostered referral relationships.
Project ECHO format with case- and evidence-based experiential learning addressing practical, relevant patient care issues engaged nephrology clinicians and motivated them to implement primary palliative care skills into their practices. These preliminary findings suggest a potentially fruitful approach to gain nephrology clinician buy-in to primary palliative care and warrant further study and collaboration.
- Private Foundation Support