Advancing palliative care in patients with CKD : from ideas to practice

Article

CHIU, Helen H.-L. | MURPHY-BURKE, Donna M. | THOMAS, Sarah A. | MELNYK, Yuriy | KRUTHAUP-HARPER, Alexandra L. | DONG, Janghu James | DJURDJEV, Ognjenka | SAUNDERS, Sushila | LEVIN, Adeera | KARIM, Mohamud | HARGROVE, Gaylene M. | BC RENAL PALLIATIVE CARE COMMITTEE

A palliative approach to care focuses on what matters most to patients with life-limiting illness, including chronic kidney disease (CKD). Despite recent publication of related clinical practice guidelines in nephrology, there is limited information about how to practically implement these recommendations. In this Perspective, we describe our experience integrating a palliative approach within routine care of patients with CKD G4-G5 across a provincial kidney care network over the past 15 years. The effort was led by a multidisciplinary group, tasked with building capacity and developing tools and resources for practical integration within a provincial network structure. We used an evidence-based framework that includes recommendations for four pillars of palliative care to guide our work: 1) patient identification, 2) advance care planning, 3) symptom assessment & management, and 4) caring of the dying patient & bereavement. Activities within each pillar have been iteratively implemented across all kidney care programs using existing committees and organizational structures. Key quality indicators were used to guide strategic planning and improvement. We supported culture change through use of multiple strategies simultaneously. Altogether, we established and integrated palliative care activities into routine CKD G4-G5 care, across the continuum from non-dialysis to dialysis populations.

http://dx.doi.org/10.1053/j.ajkd.2020.09.012

Voir la revue «American journal of kidney diseases»

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