Incorporating supportive care into the hemodialysis unit

Area of Science:

• Nephrology
• Palliative Care
• Bioethics

Background:

• Advance care planning (ACP) is crucial for aligning future medical decisions with patient values and wishes.
• Despite its benefits, ACP is underutilized in patients with dialysis-dependent kidney failure.
• Hemodialysis units often prioritize high-intensity care over supportive or palliative care, facing challenges in integration.

Purpose of the Study:

• To review the current state of advance care planning in dialysis-dependent kidney failure.
• To highlight the importance of ACP in facilitating patient-centered care and shared decision-making.
• To identify barriers and facilitators for incorporating palliative and supportive care into hemodialysis units.

Main Methods:

• Literature review of studies on advance care planning and palliative care in nephrology.
• Analysis of challenges and opportunities for integrating supportive care in hemodialysis settings.
• Exploration of the role of nephrologists in promoting ACP and shared decision-making.

Main Results:

• Advance care planning empowers patients, families, and physicians in making informed treatment decisions.
• Barriers to supportive care integration persist in hemodialysis units.
• ACP optimizes the likelihood of compassionate, timely, and supportive future care.

Conclusions:

• Palliative care may be desired by dialysis patients with declining health and comorbidities.
• Advance care planning is a prerequisite for patient-centered care in dialysis.
• Nephrologists can foster a culture of shared decision-making and palliative care support within dialysis units.