How do kidney disease clinicians view kidney supportive care and palliative care? : a qualitative study

Article indépendant

DUCHARLET, Kathryn | WEIL, Jennifer | GOCK, Hilton | PHILIP, Jennifer

Rationale & Objective: Kidney supportive care (KSC) is a developing area in medicine that integrates the expertise of nephrology and palliative practitioners to improve symptoms and quality of life for people with advanced kidney disease. The intersection of the practical aspects of KSC including care activities and clinical referrals, with palliative and end-of-life care, are largely unknown. The aim of this study was to explore kidney disease clinicians' experiences of KSC, palliative care, and end-of-life care. Study design: An exploratory qualitative study using semi-structured focus groups. Setting & Participants: Kidney disease clinicians (18 physicians, 3 trainees, and 33 kidney disease nurses) from 5 public hospitals were recruited across Victoria, Australia. Analytical approach: Thematic analysis of focus group transcripts. Results: The two overarching themes highlighted by clinicians were their perception that their healthcare systems insufficiently addressed the needs of people with advanced kidney disease, as well as their aspirations to develop KSC services to improve healthcare experiences. Three subthemes were identified related to limitations in healthcare systems including; 1) variation in the clinical scope of KSC, 2) limited integration of palliative care, and 3) experiences of challenging and compromised provision of end-of-life care. The second theme described aspirations for future KSC services to be more inclusive, seamless, and collaborative across healthcare providers with capacity to respond to meet changing palliative care needs. Limitations: (i) Findings may not be transferable to contexts outside of Victoria, Australia; (ii) Data were collected from 2017 to 2018 and may not reflect current or future experiences. Conclusions: Kidney clinicians described systemic challenges and compromises in care experiences and the need for development of kidney supportive care services. They expressed that this development would require a consistent and systematic approach that integrates palliative care and embeds kidney supportive care as part of kidney health service delivery.

http://dx.doi.org/10.1053/j.ajkd.2022.10.018

Voir la revue «American journal of kidney diseases»

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