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Dialysis discontinuation and palliative care.
L M Cohen1, M Germain, D M Poppel
1Department of Psychiatry, Baystate Medical Center, Springfield, MA 01199, USA. lewis.cohen@bhs.org
Summary
End-of-life care for dialysis patients is often overlooked. Integrating palliative medicine can improve terminal care quality, especially for those discontinuing dialysis, ensuring better patient deaths.
Area of Science:
- Nephrology
- Palliative Care
- Geriatrics
Background:
- Limited research exists on the terminal course and end-of-life care for patients discontinuing dialysis.
- Maintenance dialysis significantly impacts patient longevity but raises questions about end-of-life experiences.
Purpose of the Study:
- To prospectively examine the terminal course and end-of-life care experiences of patients who discontinued maintenance dialysis.
- To identify common symptoms and assess the quality of care during the final 24 hours of life.
Main Methods:
- Prospective cohort observational study across eight dialysis clinics (US and Canada).
- Data collected from 131 patients who died after dialysis discontinuation, with 79 prospectively followed.
- Information gathered via caregiver/family interviews and structured interviews with patients/families at dialysis cessation.
Main Results:
- The patient cohort was predominantly white (73%), elderly (mean age 70 years), and had diabetes (46%).
- Most patients (75%) had 3-7 comorbid conditions.
- Pain and agitation were the most frequent symptoms in the last 24 hours of life.
- Terminal treatment was generally perceived as satisfactory, contributing to 'good deaths' for most patients.
Conclusions:
- While dialysis extends life, palliative medicine integration into dialysis programs is crucial for enhancing end-of-life care quality.
- Recommendations include routine advance care planning and utilizing quality-of-dying measures to benchmark terminal care standards.