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Increasing hospice services for elderly patients maintained with hemodialysis
Lewis M Cohen1, Robin Ruthazer, Michael J Germain
1Department of Psychiatry, Tufts University School of Medicine, Psychiatric Consult Service, Baystate Medical Center, Springfield, Massachusetts, USA.
Journal of Palliative Medicine
|July 20, 2010
Summary
An intervention improved hospice care access for dialysis patients nearing end-of-life. This approach, involving renal supportive care teams, showed particular success in increasing hospice use among elderly patients.
Area of Science:
- Nephrology
- Palliative Care
- Geriatrics
Background:
- Limited hospice care utilization among end-stage renal disease (ESRD) patients on dialysis.
- Need for improved advance care planning and end-of-life care coordination in dialysis settings.
Purpose of the Study:
- To evaluate an intervention designed to facilitate hospice referrals for patients undergoing hemodialysis.
- To assess the impact of a multidisciplinary approach on hospice service utilization in a dialysis population.
Main Methods:
- Longitudinal prospective cohort study comparing intervention (3 clinics) and control (2 clinics) hemodialysis units.
- Formation of Renal Supportive Care Teams (RSCTs) for patient outreach, education, and advance care planning.
- Screening of 512 patients; 133 eligible patients followed for a median of 17 months.
Main Results:
- Hospice services showed a trend of increase at intervention sites (p = 0.09).
- Significant increase in hospice care utilization observed in patients aged 65 and older (p = 0.05).
- Intervention involved enhanced communication between dialysis staff and hospice providers.
Conclusions:
- Interdisciplinary collaboration and proactive patient outreach can enhance hospice access for dialysis patients.
- The intervention shows promise, particularly for improving end-of-life care for elderly ESRD patients.
- Increased familiarity between hospice and dialysis staff is key to expanding hospice use.
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