Advance care planning with patients on hemodialysis: an implementation study

Area of Science:

• Nephrology
• Palliative Care
• Implementation Science

Background:

• Patients with end-stage kidney disease (ESKD) on hemodialysis face limited life expectancy and unmet palliative care needs.
• Advance care planning (ACP) is crucial but not routinely performed for this population.
• The "Shared Decision Making and Renal Supportive Care" (SDM-RSC) intervention aims to improve ACP in ESKD patients on hemodialysis.

Purpose of the Study:

• To identify barriers and facilitators for implementing the SDM-RSC intervention.
• To understand factors influencing the uptake of ACP among hemodialysis patients.

Main Methods:

• The study utilized the Consolidated Framework for Implementation Research (CFIR) to guide the investigation.
• Data were collected through observations, surveys of nephrologists, social workers, patients, and family members, and intervention fidelity assessments.
• The CFIR framework's five domains were used to categorize identified barriers and facilitators.

Main Results:

• Barriers included intervention complexity, scheduling difficulties, need for policy change, and insufficient training.
• Facilitators comprised social worker training, leadership engagement, and the establishment of clinic champions.
• The SDM-RSC intervention was delivered to 102 out of 125 enrolled patients.

Conclusions:

• Effective implementation of ACP interventions for hemodialysis patients requires adaptation to local contexts.
• Additional training for nephrologists and social workers, alongside policy development, can routinize ACP.
• Improving ACP positively impacts end-of-life outcomes for patients and their families.