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Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?
Clin J Am Soc Nephrol. 2016 05 06; 11(5):855-66.CJ

Abstract

BACKGROUND AND OBJECTIVES

There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory.

RESULTS

The comments of providers interviewed for this study spoke to significant system-level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients.

CONCLUSIONS

The comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease.

Authors+Show Affiliations

Center of Innovation for Veteran-Centered and Value-Driven Care, Hospital and Specialty Medicine Service, and Departments of Medicine and ann.ohare@va.gov.Center of Innovation for Veteran-Centered and Value-Driven Care.Center of Innovation for Veteran-Centered and Value-Driven Care.Anthropology, University of Washington, Seattle, Washington;Department of Medicine, Division of Geriatrics, University of California, San Francisco, California; Department of Medicine, San Francisco Department of Veterans Affairs Medical Center, San Francisco, California;Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California.Center of Innovation for Veteran-Centered and Value-Driven Care, Hospital and Specialty Medicine Service, and.Departments of Medicine and Departments of Medicine and.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

27084877

Citation

O'Hare, Ann M., et al. "Provider Perspectives On Advance Care Planning for Patients With Kidney Disease: Whose Job Is It Anyway?" Clinical Journal of the American Society of Nephrology : CJASN, vol. 11, no. 5, 2016, pp. 855-66.
O'Hare AM, Szarka J, McFarland LV, et al. Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway? Clin J Am Soc Nephrol. 2016;11(5):855-66.
O'Hare, A. M., Szarka, J., McFarland, L. V., Taylor, J. S., Sudore, R. L., Trivedi, R., Reinke, L. F., & Vig, E. K. (2016). Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway? Clinical Journal of the American Society of Nephrology : CJASN, 11(5), 855-66. https://doi.org/10.2215/CJN.11351015
O'Hare AM, et al. Provider Perspectives On Advance Care Planning for Patients With Kidney Disease: Whose Job Is It Anyway. Clin J Am Soc Nephrol. 2016 05 6;11(5):855-66. PubMed PMID: 27084877.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway? AU - O'Hare,Ann M, AU - Szarka,Jackie, AU - McFarland,Lynne V, AU - Taylor,Janelle S, AU - Sudore,Rebecca L, AU - Trivedi,Ranak, AU - Reinke,Lynn F, AU - Vig,Elizabeth K, Y1 - 2016/04/15/ PY - 2015/10/24/received PY - 2015/01/21/accepted PY - 2016/4/17/entrez PY - 2016/4/17/pubmed PY - 2017/12/14/medline KW - advance care planning KW - care complexity KW - chronic kidney disease KW - communication KW - cooperative behavior KW - decision making KW - end-of-life KW - grounded theory KW - humans KW - multidisciplinary KW - renal dialysis SP - 855 EP - 66 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 11 IS - 5 N2 - BACKGROUND AND OBJECTIVES: There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory. RESULTS: The comments of providers interviewed for this study spoke to significant system-level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients. CONCLUSIONS: The comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/27084877/Provider_Perspectives_on_Advance_Care_Planning_for_Patients_with_Kidney_Disease:_Whose_Job_Is_It_Anyway L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=27084877 DB - PRIME DP - Unbound Medicine ER -