A Descriptive Analysis of an Ambulatory Kidney Palliative Care Program

Area of Science:

• Nephrology
• Palliative Care
• Health Services Research

Background:

• Patients with serious kidney disease experience significant symptom burden, high mortality, and reduced quality of life.
• Access to specialized palliative care services is often limited for nephrology patients.
• Integrating palliative care within nephrology practices can address these unmet needs.

Purpose of the Study:

• To describe the patient demographics and clinical activities of an integrated ambulatory kidney palliative care (KPC) program.
• To evaluate the utilization of clinical services, symptom burden, and patient satisfaction within the KPC program.
• To assess the feasibility and impact of a palliative care model embedded in nephrology.

Main Methods:

• Chart abstractions were used to collect data on patient demographics and clinical activities over 13 months.
• The Integrated Palliative Care Outcome Scale-Renal (IPOS-R) was utilized to assess symptom burden.
• Patient satisfaction was evaluated through returned surveys.

Main Results:

• The program served 55 patients, with a mean age of 72.0 years; 95% had advanced chronic kidney disease (CKD stage IV or V).
• The mean IPOS-R score was 16, with an average of 7.5 physical symptoms per patient.
• Key interventions included advance care planning (87%), medication adjustments for symptoms (55.4%), and dialysis decision-making discussions (35.5%).
• Overall patient satisfaction was high, with 96% reporting positive experiences.

Conclusions:

• An integrated ambulatory KPC program effectively serves high-risk patients with serious kidney disease.
• This model of care can potentially fill documented gaps in palliative care for nephrology patients.
• Early findings suggest this integrated approach enhances patient-centered palliative nephrology care and achieves high patient satisfaction.