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Shared decision-making in end-stage renal disease: a protocol for a multi-center study of a communication intervention to improve end-of-life care for dialysis patients.
BMC Palliat Care. 2015 Jun 12; 14:30.BP

Abstract

BACKGROUND

End-stage renal disease carries a prognosis similar to cancer yet only 20 % of end-stage renal disease patients are referred to hospice. Furthermore, conversations between dialysis team members and patients about end-of-life planning are uncommon. Lack of provider training about how to communicate prognostic data may contribute to the limited number of end-of-life care discussions that take place with this chronically ill population. In this study, we will test the Shared Decision-Making Renal Supportive Care communication intervention to systematically elicit patient and caretaker preferences for end-of-life care so that care concordant with patients' goals can be provided.

METHODS/DESIGN

This multi-center study will deploy an intervention to improve end-of-life communication for hemodialysis patients who are at high risk of death in the ensuing six months. The intervention will be carried out as a prospective cohort with a retrospective cohort serving as the comparison group. Patients will be recruited from 16 dialysis units associated with two large academic centers in Springfield, Massachusetts and Albuquerque, New Mexico. Critical input from patient advisory boards, a stakeholder panel, and initial qualitative analysis of patient and caretaker experiences with advance care planning have informed the communication intervention. Rigorous communication training for hemodialysis social workers and providers will ensure that standardized study procedures are performed at each dialysis unit. Nephrologists and social workers will communicate prognosis and provide advance care planning in face-to-face encounters with patients and families using a social work-centered algorithm. Study outcomes including frequency and timing of hospice referrals, patient and caretaker satisfaction, quality of end-of-life discussions, and quality of death will be assessed over an 18 month period.

DISCUSSION

The Shared Decision-Making Renal Supportive Care Communication intervention intends to improve discussions about prognosis and end-of-life care with end-stage renal disease patients. We anticipate that the intervention will help guide hemodialysis staff and providers to effectively participate in advance care planning for patients and caretakers to establish preferences and goals at the end of life.

TRIAL REGISTRATION

NCT02405312.

Authors+Show Affiliations

Division of Nephrology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Aeneanya@partners.org.Division of General Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, MA, USA. Sarah.GoffMD@baystatehealth.org. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA. Sarah.GoffMD@baystatehealth.org.Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA. Talayam@salud.unm.edu.Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA. Natalie.gutierrez@baystatehealth.org.Department of Psychiatry, Baystate Medical Center, Springfield, MA, USA. Jamie.klingensmith@baystatehealth.org.Bouve College of Health Sciences, Northeastern University, Boston, MA, USA. Jo.griffith@neu.edu.School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA. Garvey.ca@husky.neu.edu.Kitsen and Associates, Chester, CT, USA. Jkitsen@ne-esrd.org.Division of Nephrology, Department of Internal Medicine, Baystate Medical Center, Springfield, MA, USA. Michael.Germain@baystatehealth.org.Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA. LMarr@salud.unm.edu.Smith College School for Social Work, Smith College, Northampton, MA, USA. Jberzoff@smith.edu.Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA. Mlunruh@salud.unm.edu.Department of Psychiatry, Baystate Medical Center, Springfield, MA, USA. Lewis.Cohen@baystatehealth.org.

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26066323

Citation

Eneanya, Nwamaka D., et al. "Shared Decision-making in End-stage Renal Disease: a Protocol for a Multi-center Study of a Communication Intervention to Improve End-of-life Care for Dialysis Patients." BMC Palliative Care, vol. 14, 2015, p. 30.
Eneanya ND, Goff SL, Martinez T, et al. Shared decision-making in end-stage renal disease: a protocol for a multi-center study of a communication intervention to improve end-of-life care for dialysis patients. BMC Palliat Care. 2015;14:30.
Eneanya, N. D., Goff, S. L., Martinez, T., Gutierrez, N., Klingensmith, J., Griffith, J. L., Garvey, C., Kitsen, J., Germain, M. J., Marr, L., Berzoff, J., Unruh, M., & Cohen, L. M. (2015). Shared decision-making in end-stage renal disease: a protocol for a multi-center study of a communication intervention to improve end-of-life care for dialysis patients. BMC Palliative Care, 14, 30. https://doi.org/10.1186/s12904-015-0027-x
Eneanya ND, et al. Shared Decision-making in End-stage Renal Disease: a Protocol for a Multi-center Study of a Communication Intervention to Improve End-of-life Care for Dialysis Patients. BMC Palliat Care. 2015 Jun 12;14:30. PubMed PMID: 26066323.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Shared decision-making in end-stage renal disease: a protocol for a multi-center study of a communication intervention to improve end-of-life care for dialysis patients. AU - Eneanya,Nwamaka D, AU - Goff,Sarah L, AU - Martinez,Talaya, AU - Gutierrez,Natalie, AU - Klingensmith,Jamie, AU - Griffith,John L, AU - Garvey,Casey, AU - Kitsen,Jenny, AU - Germain,Michael J, AU - Marr,Lisa, AU - Berzoff,Joan, AU - Unruh,Mark, AU - Cohen,Lewis M, Y1 - 2015/06/12/ PY - 2015/04/29/received PY - 2015/05/29/accepted PY - 2015/6/13/entrez PY - 2015/6/13/pubmed PY - 2016/1/14/medline SP - 30 EP - 30 JF - BMC palliative care JO - BMC Palliat Care VL - 14 N2 - BACKGROUND: End-stage renal disease carries a prognosis similar to cancer yet only 20 % of end-stage renal disease patients are referred to hospice. Furthermore, conversations between dialysis team members and patients about end-of-life planning are uncommon. Lack of provider training about how to communicate prognostic data may contribute to the limited number of end-of-life care discussions that take place with this chronically ill population. In this study, we will test the Shared Decision-Making Renal Supportive Care communication intervention to systematically elicit patient and caretaker preferences for end-of-life care so that care concordant with patients' goals can be provided. METHODS/DESIGN: This multi-center study will deploy an intervention to improve end-of-life communication for hemodialysis patients who are at high risk of death in the ensuing six months. The intervention will be carried out as a prospective cohort with a retrospective cohort serving as the comparison group. Patients will be recruited from 16 dialysis units associated with two large academic centers in Springfield, Massachusetts and Albuquerque, New Mexico. Critical input from patient advisory boards, a stakeholder panel, and initial qualitative analysis of patient and caretaker experiences with advance care planning have informed the communication intervention. Rigorous communication training for hemodialysis social workers and providers will ensure that standardized study procedures are performed at each dialysis unit. Nephrologists and social workers will communicate prognosis and provide advance care planning in face-to-face encounters with patients and families using a social work-centered algorithm. Study outcomes including frequency and timing of hospice referrals, patient and caretaker satisfaction, quality of end-of-life discussions, and quality of death will be assessed over an 18 month period. DISCUSSION: The Shared Decision-Making Renal Supportive Care Communication intervention intends to improve discussions about prognosis and end-of-life care with end-stage renal disease patients. We anticipate that the intervention will help guide hemodialysis staff and providers to effectively participate in advance care planning for patients and caretakers to establish preferences and goals at the end of life. TRIAL REGISTRATION: NCT02405312. SN - 1472-684X UR - https://www.unboundmedicine.com/medline/citation/26066323/Shared_decision_making_in_end_stage_renal_disease:_a_protocol_for_a_multi_center_study_of_a_communication_intervention_to_improve_end_of_life_care_for_dialysis_patients_ L2 - https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-015-0027-x DB - PRIME DP - Unbound Medicine ER -