Process Evaluation of a Collaborative Outpatient Palliative Care Clinic for Patients with End-Stage Kidney Disease (GP145)

Outcomes 1. Attendees will gain an understanding of the unique aspects of palliative care provision to patients with end-stage kidney disease on dialysis and scalable knowledge that can be applied to the development and implementation of novel models of early non-malignant palliative care in similar ambulatory patient settings.2. Attendees will gain an understanding of the methodology of a process evaluation, which can be employed to develop supporting evidence for innovations in palliative care provision. Key Message Using a mixed methods process evaluation with a chart review and qualitative interviews, this research evaluated a novel collaborative palliative care clinic for patients with end-stage kidney disease on dialysis. Results suggest the model is feasible, beneficial, and will inform future delivery of early outpatient palliative care in non-malignant diseases. Importance End-stage kidney disease (ESKD) is a life-limiting illness with high symptom burden and mortality. Patients with ESKD on dialysis have decreased quality of life and greater health services usage at end-of-life.1 Despite established benefits of palliative care (PC), patients with ESKD experience inequitable access when compared to patients with cancer.2 Research is required to identify the optimal model for provision of early outpatient PC for patients with ESKD on dialysis. Objective(s) To perform a process evaluation of a novel outpatient PC clinic for patients with ESKD in Ottawa by developing a logic model of the clinic and assessing five process evaluation domains. Scientific Methods Utilized Clinic success is determined by achievement of logic model outcomes and performance in domains of fidelity, patient experience, reach, recruitment, and context. Evaluation inputs entail an ongoing chart review and qualitative interviews with healthcare providers (HCPs), patients, and caregivers. Analysis entails descriptive statistics, thematic analysis, and mixed methods triangulation. Results The PC clinic received 98 referrals from 2020 to 2023. 76 patients were seen in consultation, of whom 61 received follow-up.14 HCPs, three patients, and six caregivers were interviewed. Patients experienced support for quality of life and optimization of goal-concordant care. Caregivers’ needs, including support in symptom management, were met by the PC clinic. Patient needs previously unmet by the nephrology team alone were addressed by the PC team, including care transitions. PC visits occurring during dialysis sessions were perceived as beneficial, despite additional arrangements required to ensure privacy. Conclusion(s) Results of the clinic evaluation demonstrated successful processes of care and a promising impact on desired outcomes of the logic model. Participants affirmed the benefits of care provided by the PC clinic and supported continued patient access. Impact Study findings will inform early outpatient PC for patients with ESKD and guide future development of PC clinics for other organ failure.