Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project.
Am J Kidney Dis
; 68(1): 103-9, 2016 Jul.
Article
em En
| MEDLINE
| ID: mdl-26806003
ABSTRACT
BACKGROUND:
The Renal Physicians Association's clinical practice guideline recommends that physicians address advance care planning with dialysis patients. However, data are lacking about how best to implement this recommendation. STUDYDESIGN:
Quality improvement project. SETTINGS &PARTICIPANTS:
Nephrologists caring for patients treated with maintenance hemodialysis at 2 dialysis facilities identified patients who might benefit most from advance care planning using the "surprise" question ("Would I be surprised if this patient died in the next year?"). QUALITY IMPROVEMENT PLAN Patients identified with a "no" response to the surprise question were invited to participate in nephrologist-facilitated advance care planning, including completion of a Medical Orders for Life-Sustaining Treatment (MOLST) form.OUTCOMES:
Change in MOLST completion rate and identification of preferences for limits on life-sustaining treatment. MEASUREMENTS Pre- and postintervention code status, MOLST completion rate, and vital status at 1 year.RESULTS:
Nephrologists answered "no" to the surprise question for 50 of 201 (25%) hemodialysis patients. Of these, 41 (82%) patients had a full-code status and 9 (18%) had a do-not-resuscitate (DNR) status. Encounters lasted 15 to 60 minutes. Following the encounter, 21 (42%) patients expressed preference for a DNR status and 29 (58%) maintained full-code status (P=0.001). The MOLST completion rate increased from 10% to 90%. One-year survival for patients whose nephrologists answered "no" to the surprise question was 58% compared to 92% for those with a "yes" answer (P<0.001).LIMITATIONS:
Sample size and possible nonrepresentative dialysis population.CONCLUSIONS:
Nephrologist-facilitated advance care planning targeting hemodialysis patients with limited life expectancy led to significant changes in documented patient preferences for cardiopulmonary resuscitation and limits on life-sustaining treatment. These changes demonstrate the benefit of advance care planning with dialysis patients and likely reflect better understanding of end-of-life treatment options.Palavras-chave
Advance care planning; cardiopulmonary resuscitation; code status; do not resuscitate (DNR); end-of-life care; end-stage renal disease (ESRD); hemodialysis; life expectancy; medical orders for life-sustaining treatment (MOLST); physician orders for life-sustaining treatment (POLST); quality improvement; shared decision making
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Diálise Renal
/
Planejamento Antecipado de Cuidados
/
Melhoria de Qualidade
/
Nefrologistas
Tipo de estudo:
Clinical_trials
/
Guideline
/
Prognostic_studies
Limite:
Aged
/
Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article