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Kidney Week

Abstract: FR-PO883

Understanding Patient Engagement in Advance Care Planning

Session Information

  • 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

Authors

  • Ducharlet, Kathryn, Monash University Eastern Health Clinical School, Box Hill, Victoria, Australia
  • Degen, Dov, Eastern Health, Box Hill, Victoria, Australia
  • Nguyen, Dao Anh Thi, Eastern Health, Box Hill, Victoria, Australia
  • Colquhoun, Lisa, Eastern Health, Box Hill, Victoria, Australia
  • Brean, Samantha Jane, Eastern Health, Box Hill, Victoria, Australia
  • Habjan, Kelly, Eastern Health, Box Hill, Victoria, Australia
  • William, Leeroy, Eastern Health, Box Hill, Victoria, Australia
  • McMahon, Lawrence P., Monash University Eastern Health Clinical School, Box Hill, Victoria, Australia
Background

Approaches enabling shared decision-making for serious illness and end-of-life care with kidney patients are variable with significant challenges. There is no systematic approach to introduce these conversations and data understanding patient engagement is limited.

Methods

An interventional mixed methods study aimed to understand patient perspectives of advance care planning (ACP) at a single kidney care centre in Australia (Figure 1). A 1-hour conversation between kidney clinicians (nurse or doctor) and patients provided information regarding kidney health, and ACP concepts were introduced. Descriptive statistics and paired t-tests estimated the effect of the intervention and qualitative data were analysed thematically.

Results

Between December 2022 and April 2023, 47 kidney patients were consented: 40 in Part A and 7 in Part B. The average age was 80 years, 57% male, 57% Australian-born, 81% English speaking, 37% CKD, 47% satellite dialysis, 14% home dialysis. Participants’ perceived kidney disease related self-efficacy was high, with few symptoms of depression or anxiety. Median time between interview and follow up feedback was 6 weeks [IQR 4,9]. During this period 64% of people reported having an ACP conversation with family or caregivers. The intervention showed an improvement in mean “readiness to formally ask someone to be a medical decision maker” (3.2[1.9] to 3.8[1.6], p=0.04). No improvement on other dimensions of ACP engagement was found. Preliminary analysis of qualitative data highlighted disabling patient factors that hindered ACP engagement, including: 1. Perceived cultural and physical barriers to communication. 2. Coping strategies focused on living in the present. 3. Differing perceptions of the utility of end-of-life discussions. 4. Distress and fear at the prospect of serious illness or death.

Conclusion

These findings suggest that the intervention facilitated conversations between patients and their of medical decision makers. This study also highlights the social and psychological factors which impact patient engagement in future treatment planning.

Funding

  • Other NIH Support