Renal supportive care: Current experiences in victoria

Abstract

Background: Patients with advanced Chronic Kidney Disease (CKD) have a high burden of physical and psychosocial morbidity, frequently associated with frailty and limited prognosis. Renal Supportive Care (RSC) is increasingly recognised as a valid non-dialysis, non-transplantation pathway for many of these patients. However, understanding the role, timing and application of RSC amongst healthcare providers is not known. Aim(s): To explore current attitudes and experiences of RSC and Palliative Care by renal clinicians. Method(s): An exploratory qualitative study was conducted across 5 Victorian hospitals. Focus groups and semi-structured interviews of renal clinicians were audio recorded and transcribed for thematic analysis by two independent researchers. Result(s): Of participants recruited (n=58), there were 35 nurses (3 practitioners, 2 educators, 5 ward, 25 dialysis) and 23 doctors (5 nephrology trainees, 18 nephrologists). Clinical experience ranged from 0.5-40 years. Four major themes emerged on preliminary analysis: 1) Perceptions and practices of RSC vary substantially. However, RSC is perceived more acceptable for patients than Palliative Care. 2) Compared with dialysis, non-dialysis patients have a poorly defined pathway of care that is not well resourced. 3) Both dialysis and non-dialysis CKD patients have few, readily identified transition points to herald the final phase-of-life. Therefore, its recognition is inconsistent. 4) At end-of-life, patients, families and treating teams frequently have differing views on active management, continuation of life-supporting therapy and only providing comfort measures. Conclusion(s): The perception and understanding of RSC varies widely. RSC may improve care for some patients but a consistent approach is lacking. There is a need for a consensus RSC pathway and resources may be required for service development and health service integration.