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Concurrent Hospice and Dialysis Care: Considerations for Implementation.

Natalie C Ernecoff1, Mayumi T Robinson2, Erica M Motter2

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This summary is machine-generated.

Concurrent hospice and dialysis care improves end-of-life support for patients with end-stage kidney disease (ESKD). Key elements include timely goals-of-care discussions, interdisciplinary teamwork, clear guidelines, and supportive hospice payment policies for better implementation.

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Area of Science:

  • Palliative Care
  • Nephrology
  • Health Services Research

Background:

  • Hospice care significantly enhances end-of-life experiences for patients and families.
  • Patients undergoing dialysis are half as likely to receive hospice care compared to the general Medicare population.
  • Concurrent hospice and dialysis care presents a vital opportunity to improve care for individuals with end-stage kidney disease (ESKD).

Purpose of the Study:

  • To develop a conceptual model for concurrent hospice and dialysis care.
  • To identify essential components, resources, and considerations for implementing this integrated care model.

Main Methods:

  • Qualitative interviews were conducted with patients, caregivers, clinicians, and policy experts.
  • A community advisory panel (CAP) provided feedback on the concurrent care model.
  • Template analysis was used to analyze qualitative data.

Main Results:

  • Four themes emerged for effective concurrent care: timely goals-of-care conversations, interdisciplinary approach, clear transition guidelines, and supportive hospice payment policies.
  • The CAP offered input on model phases and necessary resources like educational materials and communication tools.
  • Participants highlighted the need for refined design, implementation strategies, and resource allocation.

Conclusions:

  • A conceptual model and resource list for concurrent hospice and dialysis care were developed.
  • Policy changes, clinical implementation, and educational resources are crucial for scalable and equitable dissemination.
  • Systematic evaluation through a hybrid implementation-effectiveness trial is recommended to assess this integrated care model.