Planning For End Of Life Care In Dialysis

Background With the increasing age and complex comorbidities of dialysis patients globally, there has been increased attention to planning for end of life care (EoLC) and advanced care directives.Objectives We sought to understand the thoughts and experiences of dialysis patients in relation to EoLC planning.Methods An eight-question closed-ended survey at two time points 12 months apart through our Renal Supportive Care Program. All people undergoing dialysis in the service were invited to participate.Results There were good response rates to the survey at both time points (T) (T1 n=224 T2 n=247) and, for the majority, planning for EoLC was considered to be very important (80%). However, only 23% reported having a conversation with their healthcare provider regarding advanced care directives and only 30% had documented their future care goals. At T2 there was an increased awareness of planning in this population which resulted in an improvement in advanced care directives (40%). This study suggests that there is a subgroup of patients who are aware of advanced care directives but do not have any in place.Conclusion There is an ongoing reluctance in dialysis units by patients to have a conversation with their healthcare providers regarding advance care directives despite this population being at heightened risk of deterioration. This is likely impacting on the delivery of complex and possibly unnecessary and unwanted invasive care in the last year/s of life.