Implementing Advance Care Planning for dialysis patients: HIGHway project

Area of Science:

• Nephrology
• Palliative Care
• Implementation Science

Background:

• Patients on hemodialysis face high mortality and underutilize palliative care.
• Existing interventions like SDM-RSC showed success in improving advance directives.
• The HIGHway Project adapts SDM-RSC to scale up advance care planning (ACP) training for dialysis centers.

Purpose of the Study:

• To implement and evaluate an advance care planning (ACP) intervention for patients undergoing hemodialysis.
• To train social workers and nurses in dialysis centers to conduct ACP conversations.
• To improve patient-centered, goal-concordant end-of-life care for dialysis patients.

Main Methods:

• Training 50-60 dialysis teams using the Knowledge to Action (KTA) Framework and Consolidated Framework for Implementation Research (CFIR).
• Providing a curriculum, monthly coaching via teleconferences, and an application software for ACP guidance.
• Focusing on implementation outcomes, including adoption, effective use of ACP, and documentation of conversations.

Main Results:

• The HIGHway Project is currently in the recruitment stage.
• Implementation outcomes will be measured by the adoption and effective use of the ACP approach.
• Patient and provider outcomes will include the number and quality of ACP conversations and app usage.

Conclusions:

• Implementing effective ACP processes in dialysis centers can drive institutional policy changes.
• This initiative offers a scalable model for improving ACP for US dialysis patients.
• Widespread improvement in ACP can address barriers to patient-centered, goal-concordant care.