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Clinicians' Perspectives on Advance Care Planning for Patients With CKD in Australia: An Interview Study.
Am J Kidney Dis. 2017 Sep; 70(3):315-323.AJ

Abstract

BACKGROUND

Advance care planning (ACP) empowers patients to consider and communicate their current and future treatment goals. However, ACP is not widely implemented in chronic kidney disease (CKD) care settings. This study aims to describe clinicians' beliefs, challenges, and perspectives of ACP in patients with CKD.

STUDY DESIGN

Qualitative study.

SETTING & PARTICIPANTS

Nephrologists (n=20), nurses (n=7), and social workers (n=4) with a range of experience in facilitating ACP for patients with CKD across Australia.

METHODOLOGY

Semistructured interviews were digitally recorded and transcribed verbatim.

ANALYTICAL APPROACH

Transcripts were analyzed using thematic analysis.

RESULTS

5 major themes were identified: facilitating informed decision making (avoiding preconceptions, conveying complete truths, focusing on supportive care, and synchronizing with evolving priorities), negotiating moral boundaries (contending with medical futility and respecting patient vs family autonomy), navigating vulnerable conversations (jeopardizing the therapeutic relationship, compromising professional confidence, emotionally invested, and enriching experiences), professional disempowerment (unsupportive culture, doubting logistical feasibility, and making uncertain judgments), and clarifying responsibilities (governing facilitation, managing tensions, and transforming multidisciplinary relationships).

LIMITATIONS

Some findings may be specific to the Australian context.

CONCLUSIONS

The tensions among themes reflect that ACP is paradoxically rewarding for clinicians because ACP empowers patients yet can expose personal and professional vulnerabilities. Clinicians believe that a more collaborative approach is needed, with increased efforts to identify the evolving and individualized needs and goals of patients with CKD. Models of ACP that address clinicians' personal and professional vulnerabilities when initiating ACP may foster greater confidence and cultural acceptance of ACP in the CKD setting.

Authors+Show Affiliations

Sydney Medical School, The University of Sydney, Sydney, Australia.Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Australia.Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales, Australia; Faculty of Health, University of Technology Sydney (UTS), Australia.NHMRC Clinical Trials Centre, The University of Sydney, Australia.Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Renal Medicine, Royal North Shore Hospital, Australia.NHMRC Clinical Trials Centre, The University of Sydney, Australia.Sydney Medical School, The University of Sydney, Sydney, Australia.Sydney Medical School, The University of Sydney, Sydney, Australia; Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales, Australia; HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, Australia. Electronic address: josephine.clayton@sydney.edu.au.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28216281

Citation

Sellars, Marcus, et al. "Clinicians' Perspectives On Advance Care Planning for Patients With CKD in Australia: an Interview Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 70, no. 3, 2017, pp. 315-323.
Sellars M, Tong A, Luckett T, et al. Clinicians' Perspectives on Advance Care Planning for Patients With CKD in Australia: An Interview Study. Am J Kidney Dis. 2017;70(3):315-323.
Sellars, M., Tong, A., Luckett, T., Morton, R. L., Pollock, C. A., Spencer, L., Silvester, W., & Clayton, J. M. (2017). Clinicians' Perspectives on Advance Care Planning for Patients With CKD in Australia: An Interview Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 70(3), 315-323. https://doi.org/10.1053/j.ajkd.2016.11.023
Sellars M, et al. Clinicians' Perspectives On Advance Care Planning for Patients With CKD in Australia: an Interview Study. Am J Kidney Dis. 2017;70(3):315-323. PubMed PMID: 28216281.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinicians' Perspectives on Advance Care Planning for Patients With CKD in Australia: An Interview Study. AU - Sellars,Marcus, AU - Tong,Allison, AU - Luckett,Tim, AU - Morton,Rachael L, AU - Pollock,Carol A, AU - Spencer,Lucy, AU - Silvester,William, AU - Clayton,Josephine M, Y1 - 2017/02/17/ PY - 2016/07/19/received PY - 2016/11/27/accepted PY - 2017/2/22/pubmed PY - 2017/9/13/medline PY - 2017/2/21/entrez KW - ACP discussions KW - Chronic kidney disease (CKD) KW - advance care planning (ACP) KW - conservative care KW - doctor-patient communication KW - end-of-life KW - informed decision-making KW - interviews KW - medical futility KW - nephrology KW - nephrology training KW - patient preferences KW - semi-structured interviews KW - shared decision making KW - supportive care SP - 315 EP - 323 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 70 IS - 3 N2 - BACKGROUND: Advance care planning (ACP) empowers patients to consider and communicate their current and future treatment goals. However, ACP is not widely implemented in chronic kidney disease (CKD) care settings. This study aims to describe clinicians' beliefs, challenges, and perspectives of ACP in patients with CKD. STUDY DESIGN: Qualitative study. SETTING & PARTICIPANTS: Nephrologists (n=20), nurses (n=7), and social workers (n=4) with a range of experience in facilitating ACP for patients with CKD across Australia. METHODOLOGY: Semistructured interviews were digitally recorded and transcribed verbatim. ANALYTICAL APPROACH: Transcripts were analyzed using thematic analysis. RESULTS: 5 major themes were identified: facilitating informed decision making (avoiding preconceptions, conveying complete truths, focusing on supportive care, and synchronizing with evolving priorities), negotiating moral boundaries (contending with medical futility and respecting patient vs family autonomy), navigating vulnerable conversations (jeopardizing the therapeutic relationship, compromising professional confidence, emotionally invested, and enriching experiences), professional disempowerment (unsupportive culture, doubting logistical feasibility, and making uncertain judgments), and clarifying responsibilities (governing facilitation, managing tensions, and transforming multidisciplinary relationships). LIMITATIONS: Some findings may be specific to the Australian context. CONCLUSIONS: The tensions among themes reflect that ACP is paradoxically rewarding for clinicians because ACP empowers patients yet can expose personal and professional vulnerabilities. Clinicians believe that a more collaborative approach is needed, with increased efforts to identify the evolving and individualized needs and goals of patients with CKD. Models of ACP that address clinicians' personal and professional vulnerabilities when initiating ACP may foster greater confidence and cultural acceptance of ACP in the CKD setting. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/28216281/Clinicians'_Perspectives_on_Advance_Care_Planning_for_Patients_With_CKD_in_Australia:_An_Interview_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(17)30004-5 DB - PRIME DP - Unbound Medicine ER -