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Advance care planning in chronic kidney disease: A survey of current practice in Australia.
Nephrology (Carlton). 2017 Feb; 22(2):139-149.N

Abstract

AIM

Advance care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice and identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches.

METHODS

An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future.

RESULTS

A total of 375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%) with 54% indicated that ACP at their workplace was performed ad hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (odds ratio (OR) 4.96, 95% confidence intervals (CI) 1.74-14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38-49.79).

CONCLUSION

Advance care planning in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multidisciplinary approach with a gradient of ACP expertise is also recommended.

Authors+Show Affiliations

Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales, New South Wales, Australia. Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia.Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia. Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia.Respecting Patient Choices, Austin Health, Melbourne, Victoria, Australia.Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia. Respecting Patient Choices, Austin Health, Melbourne, Victoria, Australia.Respecting Patient Choices, Austin Health, Melbourne, Victoria, Australia.School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales, New South Wales, Australia. Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia. HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, New South Wales.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26860214

Citation

Luckett, Tim, et al. "Advance Care Planning in Chronic Kidney Disease: a Survey of Current Practice in Australia." Nephrology (Carlton, Vic.), vol. 22, no. 2, 2017, pp. 139-149.
Luckett T, Spencer L, Morton RL, et al. Advance care planning in chronic kidney disease: A survey of current practice in Australia. Nephrology (Carlton). 2017;22(2):139-149.
Luckett, T., Spencer, L., Morton, R. L., Pollock, C. A., Lam, L., Silvester, W., Sellars, M., Detering, K. M., Butow, P. N., Tong, A., & Clayton, J. M. (2017). Advance care planning in chronic kidney disease: A survey of current practice in Australia. Nephrology (Carlton, Vic.), 22(2), 139-149. https://doi.org/10.1111/nep.12743
Luckett T, et al. Advance Care Planning in Chronic Kidney Disease: a Survey of Current Practice in Australia. Nephrology (Carlton). 2017;22(2):139-149. PubMed PMID: 26860214.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance care planning in chronic kidney disease: A survey of current practice in Australia. AU - Luckett,Tim, AU - Spencer,Lucy, AU - Morton,Rachael L, AU - Pollock,Carol A, AU - Lam,Lawrence, AU - Silvester,William, AU - Sellars,Marcus, AU - Detering,Karen M, AU - Butow,Phyllis N, AU - Tong,Allison, AU - Clayton,Josephine M, PY - 2015/12/22/received PY - 2016/02/03/revised PY - 2016/02/05/accepted PY - 2016/2/11/pubmed PY - 2017/3/14/medline PY - 2016/2/11/entrez KW - advance care planning KW - chronic kidney disease KW - conservative care KW - current practice KW - health professional view SP - 139 EP - 149 JF - Nephrology (Carlton, Vic.) JO - Nephrology (Carlton) VL - 22 IS - 2 N2 - AIM: Advance care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice and identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches. METHODS: An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future. RESULTS: A total of 375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%) with 54% indicated that ACP at their workplace was performed ad hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (odds ratio (OR) 4.96, 95% confidence intervals (CI) 1.74-14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38-49.79). CONCLUSION: Advance care planning in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multidisciplinary approach with a gradient of ACP expertise is also recommended. SN - 1440-1797 UR - https://www.unboundmedicine.com/medline/citation/26860214/Advance_care_planning_in_chronic_kidney_disease:_A_survey_of_current_practice_in_Australia_ L2 - https://doi.org/10.1111/nep.12743 DB - PRIME DP - Unbound Medicine ER -