Volume 11, Issue 2, Pages 50-58 (October 2009)

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ABSTRACT

ABSTRACT + REFS

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Experience of a Renal Palliative Care Program in a Hong Kong Center: Characteristics of Patients Who Prefer Palliative Care to Dialysis

Background

A renal palliative care (RPC) program was developed in a local center as an option for patients with end-stage renal disease (ESRD) who may not benefit from dialysis or who do not prefer dialysis. The model involved collaboration between the palliative care and renal teams, and the RPC program was introduced as an option in the advance care planning (ACP) interview during which treatment benefits, burdens, predicted prognosis and the patient's preferences were discussed. Patients who preferred palliative care to dialysis were recruited into the RPC program. An interdisciplinary team approach was adopted and the Renal Palliative Clinic comprised the core component among the full spectrum of services.

Methods

This was a retrospective study of the characteristics of ESRD patients who were interviewed for ACP between August 2007 and the end of 2008 and who preferred palliative care to dialysis.

Results

A total of 96 ESRD patients were interviewed for ACP during this period, among which 36 patients opted for dialysis while 60 patients chose RPC. In both groups, around 97% of patients were mentally competent and involved in ACP. The patients who chose RPC, as compared with the patients who opted for dialysis, were older (74.1 ± 8.7 years vs. 56.3 ± 10.0 years, p< 0.001), included more widowers (40.0% vs. 2.8%, p<0.001), were more financially dependent on their family (65.0% vs. 36.1%, p< 0.001), had a higher incidence of diabetes mellitus (73.4% vs. 41.6%, p= 0.002), and had a higher modified Charlson Comorbidity Index (9.5 ± 1.9 vs. 6.9 ± 3.1, p< 0.001). More RPC patients relied on assistance to walk and had a constant caregiver at home. The decision for RPC was primarily the patient's in 41.7%, while it was a shared family decision in 56.5%. The reasons given for declining dialysis were perceived undue physical burden in 60.1%, social burden in 53.4%, and psychological burden in 56.8%, while 35.1% of patients cited all of the above reasons for their decision. By the end of 2008, 30 (50.0%) RPC patients had died, after receiving palliative care for a median duration of 132.5 days (range, 3–437 days; interquartile range, 115.0). They all lived with their choice of RPC until death.

Conclusion

The RPC program, introduced as an option in ACP, was appropriate in meeting the preferences and needs of a significant proportion of ESRD patients and their families.

Key words: advance care planning , dialysis , end-stage renal disease , Hong Kong , palliative care

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Article Outline

• Abstract

• References

• Copyright

References

1. 1 Home Dialysis Central . Dialysis Museum . Available at http://www.homedialysis.org/learn/museum/ [Date accessed: January 20, 2009] .

2. 2 Panel Holds Life-or-Death in Allotting of Artificial Kidney. May 6, 1962. New York Times Archive. Available at http://www.nytimes.com/ref/membercenter/nytarchive.html [Date accessed: January 20, 2009]

3. 3 World Health Organization . WHO Definition of Palliative Care . Available at http://www.who.int/cancer/palliative/definition/en/ [Date accessed: January 16, 2009] .

4. 4 United States Renal Data System . Annual Data Report. 2002 and 2008 . Available at http://www.usrds.org/adr.htm [Date accessed: January 19, 2009] .

5. 5 Merkus MP , Jager KJ , Dekker FW , de Haan RJ , Boeschoten EW , Krediet RT . Physical symptoms and quality of life in patients on chronic dialysis: results of The Netherlands Cooperative Study on Adequacy of Dialysis (NECOSAD) . Nephrol Dial Transplant . 1999;14:1163–1170 . MEDLINE | CrossRef

6. 6 Weisbord SD , Carmody SS , Bruns FJ , Rotondi AJ , Cohen LM , Zeidel ML , et al. Symptom burden, quality of life, advance care planning and the potential value of palliative care in severely ill haemodialysis patients . Nephrol Dial Transplant . 2003;18:1345–1352 . MEDLINE | CrossRef

7. 7 Cohen SD , Norris L , Acquaviva K , Perterson RA , Kimmel PL . Screening, diagnosis, and treatment of depression in patients with end-stage renal disease . Clin J Am Soc Nephrol . 2007;2:1332–1342 .

8. 8 Moss AH , Holley JL , Davison SN , Dart RA , Germain MJ , Cohen L . Core curriculum in nephrology . Am J Kidney Dis . 2004;43:172–185 . Full Text | Full-Text PDF (162 KB) | CrossRef

9. 9 Germain MJ , Cohen LM , Davison SN . Withholding and withdrawal from dialysis: what we know about how our patients die . Semin Dial . 2007;20:195–199 . MEDLINE | CrossRef

10. 10 Bajwa K , Szabo E , Kjellstrand CM . A prospective study of risk factors and decision making in discontinuation of dialysis . Arch Intern Med . 1996;156:2571–2577 . MEDLINE

11. 11 Cheng YL. Perspectives from Hong Kong Renal Registry. Presented at the Symposium on Supportive Care for Patients with Renal Failure, January 11, 2009. Hong Kong Hospital Authority.

12. 12 Mok E , Lai C , Zhang ZX . Coping with chronic renal failure in Hong Kong . Int J Nurs Stud . 2004;41:205–213 . Abstract | Full Text | Full-Text PDF (210 KB) | CrossRef

13. 13 Yong SP , Kwok OL , Wong D , Suen HP , Chen WT , Tse MW . Symptom burden and quality of life in end-stage renal disease: a study of 179 patients on dialysis and palliative care . Palliat Med . 2009;23:111 . CrossRef

14. 14 Murtagh FE , Addington-Hall J , Higginson IJ . The prevalence of symptoms in end-stage renal disease: a systematic review . Adv Chronic Kidney Dis . 2007;14:82–99 . Abstract | Full Text | Full-Text PDF (344 KB) | CrossRef

15. 15 Saini T , Murtagh FE , Dupont PJ , McKinnon PM , Hatfield P , Saunders Y . Comparative pilot study of symptoms and quality of life in cancer patients and patients with end stage renal disease . Palliat Med . 2006;20:631–636 . MEDLINE | CrossRef

16. 16 Moss AH . A new clinical practice guideline on initiation and withdrawal of dialysis that makes explicit the role of palliative medicine . J Palliat Med . 2000;3:253–260 . MEDLINE | CrossRef

17. 17 Building a Healthy Tomorrow: Discussion Paper for the Future Service Delivery Model for Our Health Care System . Hong Kong: Health and Medical Development Advisory Committee; 2005; Available at http://www.fhb.gov.hk/hmdac/english/papers/files/hmdac_paper.pdf [Date accessed: December 28, 2008] .

18. 18 Beddhu S , Bruns FJ , Saul M , Seddon P , Zeidel ML . A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients . Am J Med . 2000;108:609–613 . Abstract | Full Text | Full-Text PDF (91 KB) | CrossRef

19. 19 Murtagh FE , Marsh JE , Donohoe P , Ekbal NJ , Sheerin NS , Harris FE . Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5 . Nephrol Dial Transplant . 2007;22:1955–1962 . MEDLINE | CrossRef

20. 20 Lamping DL , Constantinovici N , Roderick P , Normand C , Henderson L , Harris S , et al. Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study . Lancet . 2000;356:1543–1550 . Abstract | Full Text | Full-Text PDF (158 KB) | CrossRef

21. 21 Merkus MP , Jager KJ , Dekker FW , de Haan RJ , Boeschoten EW , Krediet RT . Predictors of poor outcome in chronic dialysis patients: The Netherlands Cooperative Study on the Adequacy of Dialysis. The NECOSAD Study Group . Am J Kidney Dis . 2000;35:69–79 . Abstract | Full Text | Full-Text PDF (60 KB) | CrossRef

22. 22 Sesso R , Rodrigues-Neto JF , Ferraz MB . Impact of socioeconomic status on the quality of life of ESRD patients . Am J Kidney Dis . 2003;41:186–195 . Abstract | Full-Text PDF (64 KB) | CrossRef

23. 23 Revuelta KL , Lopez FJG , de Alvaro Moreno F , Alonso J , for the CALVIDIA Group . Perceived mental health at the start of dialysis as a predictor of morbidity and mortality in patients with end-stage renal disease (CALVIDIA Study) . Nephrol Dial Transplant . 2004;19:2347–2353 . MEDLINE | CrossRef

24. 24 Moss AH , Holley JL , Upton MB . Outcome of CPR in dialysis patients . J Am Soc Nephrol . 1992;3:1238–1243 . MEDLINE

25. 25 Chan HM . Informed consent Hong Kong style: an instance of moderate familism . J Med Philos . 2004;29:195–206 . MEDLINE | CrossRef

26. 26 World Health Organization . WHO Guide for Effective Programmes: Cancer Control—Knowledge into Action . Available at http://www.who.int/cancer/media/FINAL-PalliativeCareModule.pdf [Date accessed: May 18, 2009] .

27. 27 Lunney JR , Lynn J , Foley DJ , Lipson S , Guralnik JM . Patterns of functional decline at the end of life . JAMA . 2003;289:2387–2392 . MEDLINE | CrossRef

28. 28 Gold Standards Framework . Prognostic Indicator Guidance, Version 2.25 . Available at http://www.goldstandardsframework.nhs.uk/Resources/Gold%20Standards%20Framework/PIG_Paper_Final_revised_v5_Sept08.pdf July 2006; [Date accessed: December 29, 2008] .

Chief of Service, Department of Medicine and Geriatrics, Caritas Medical Centre, Kowloon, Hong Kong SAR

Correspondence to: Dr. Doris Man-Wah Tse, c/o Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Kowloon, Hong Kong SAR. Fax: (+ 852) 21484399

PII: S1561-5413(09)60243-X

doi:10.1016/S1561-5413(09)60243-X

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