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Dialysis discontinuation. A 'good' death?

L M Cohen1, J D McCue, M Germain

  • 1Department of Psychiatry, Tufts University School of Medicine, Boston, MA.

Archives of Internal Medicine
|January 9, 1995
PubMed
Summary

Discontinuing long-term dialysis for end-stage renal disease patients can lead to a good death, especially when due to medical decline. However, some patients experience poor quality of death, highlighting a need for better palliative care.

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Area of Science:

  • Nephrology
  • Palliative Care
  • End-of-Life Studies

Background:

  • Approximately 10% of end-stage renal disease (ESRD) deaths result from dialysis discontinuation.
  • The quality of death following dialysis cessation is often debated.

Purpose of the Study:

  • To prospectively investigate the decision-making process for dialysis discontinuation in ESRD patients.
  • To evaluate the quality of death experienced by patients who discontinue long-term dialysis.

Main Methods:

  • A cohort of 18 patients undergoing long-term hemodialysis had dialysis discontinued in 1990.
  • Patient, provider, and family interviews were conducted for prospectively enrolled cases.
  • Quality of death was assessed using scales for duration of dying, discomfort, and psychosocial circumstances.
Keywords:
Baystate Medical Center (Springfield, MA)Death and EuthanasiaEmpirical ApproachWestern Massachusetts Kidney Center

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Main Results:

  • Patients lived a mean of 9.6 days after dialysis termination.
  • Seven of 11 prospectively studied patients had a subjectively assessed "good" quality of death.
  • A good quality of death was significantly associated with discontinuation due to medical deterioration (P = .009).

Conclusions:

  • A majority of patients in this cohort experienced a good death, based on subjective criteria.
  • Improved palliative therapies could potentially alleviate suffering, delirium, and pain in some patients.
  • The study underscores the importance of palliative care in end-of-life decision-making for ESRD patients.