Build it and They Will Come: Description of Two Kidney Palliative Care Programs

Outcomes 1. Identify the clinical scope of practice and key components of an interdisciplinary specialty kidney palliative care team.2. Explain what conservative kidney management is and the typical clinical trajectories of patients who choose it. Key Message Palliative care clinicians increasingly care for patients with kidney disease who face challenging symptoms and unique treatment decisions. We present two kidney palliative care programs and an overview of program structures, processes and care across the disease trajectory to equip clinicians with the tools to build their own kidney palliative care practice. Introduction Among the 31 million Americans with chronic kidney disease (CKD), older patients are the most common age group initiating dialysis. Patients living with advanced kidney disease experience a high symptom burden that impacts their experience and overall survival. Conservative kidney management (CKM), which is active medical care without dialysis, is rarely offered as a treatment option despite its focus on quality of life and symptom management. Objectives The objectives of this session are: 1) describe two models of kidney palliative care (KPC) programs in two academic guide institutions and 2) define program structures, referral processes and patient management strategies to clinicians interested in developing their own program. Methods We will describe two academic KPC programs that provide care for patients with kidney disease across care settings. Using case-based scenarios, we will address the following: 1) team structure and workflow with an emphasis on CKM; 2) patient identification especially for CKM - one using population health management strategies and one using traditional referral process; and 3) typical clinical trajectories with management strategies for patients who have CKM. We will conclude with participants identifying one step toward building a KPC practice at their institution. Results This session will provide a comprehensive overview of KPC across the care continuum including inpatient consults, outpatient clinic, home-based palliative care, telephone-based treatment decision-making encounters, and hospice. Participants will gain knowledge of how KPC is evolving, including the roles of the interdisciplinary team. Conclusions These KPC programs demonstrate the paramount impact they have on the lives of kidney patients. This interdisciplinary model not only helps focus on symptom management unique to kidney disease but assists in difficult conversations focusing on patient values. This session will equip participants with the knowledge and tools to consider how to start or expand their own KPC program. Keywords Models of Palliative Care Delivery; Disease specific management