Value Placed on Comfort vs Life Prolongation Among Patients Treated With Maintenance Dialysis

Area of Science:

• Nephrology
• Geriatrics
• Palliative Care

Background:

• Patients undergoing maintenance dialysis frequently receive intensive end-of-life care that may not align with their personal values.
• Understanding the relationship between patient values and their advance care planning is crucial for improving end-of-life care quality.

Purpose of the Study:

• To investigate the association between patients' healthcare values (longevity vs. comfort) and their engagement in advance care planning and end-of-life care.
• To identify potential discrepancies between patient-expressed values and actual end-of-life care received.

Main Methods:

• A survey study was conducted with patients receiving maintenance dialysis in Seattle and Nashville.
• Data included patient-reported values on care intensity, advance care planning engagement, and end-of-life care utilization via linked registry and Medicare data.
• Logistic regression models were used to analyze the association between values and care outcomes.

Main Results:

• A significant portion of patients (48.4%) valued comfort-focused care, yet many had not completed advance directives or discussed hospice or stopping dialysis.
• Patients valuing comfort care were less likely to have advance directives or discuss hospice compared to those valuing longevity or unsure.
• Despite value preferences, intensive end-of-life procedures, dialysis discontinuation, and hospice enrollment rates did not differ significantly between groups.

Conclusions:

• A notable disconnect exists between the comfort-focused values expressed by many dialysis patients and their engagement in advance care planning and end-of-life care, which often reflects a longevity focus.
• These findings underscore the need for improved communication and interventions to ensure end-of-life care aligns with patient values in the dialysis population.
• Opportunities exist to enhance the quality of care for dialysis patients by better integrating their preferences into treatment and planning decisions.