Shared Decision-Making, Advance Care Planning for Chronic Kidney Disease Patients
Jayita Deodhar, Shankar Prasad Nagaraju, Ashok L Kirpalani, Ajith M Nayak, Jayita Deodhar, Shankar Prasad Nagaraju, Ashok L Kirpalani, Ajith M Nayak
Abstract
Advance care planning (ACP) is a process by which clinicians together with patients and families reflect on and outline care goals to inform current and future care. ACP or shared decision-making is not only about key medical decisions, such as decision about continuing dialysis, or agreement for "not for resuscitation" order when in hospital. The importance of its role in chronic kidney disease (CKD) patients is less known and not being well practiced in our country. When done well, it involves enhancement of final days, weeks, and months with positive decisions about family relationships, resolution of conflict, and living well until end of life, improved quality of life, decreased anxiety and depression among family members, reduced hospitalizations, increased uptake of hospice and palliative care services, and care that concurs with patient preferences. It lays out a set of relationships, values, and processes for approaching end-of-life decisions for the patient. It also includes attention to ethical, psychosocial, and spiritual issues relating to starting, continuing, withholding, and stopping dialysis. This workshop was done to sensitize ACP as a standard of care intervention in the management of CKD in our country.
Keywords: Advance care planning; chronic kidney disease; end-stage renal disease; hemodialysis; shared decision-making.
Conflict of interest statement
There are no conflicts of interest.
Copyright: © 2021 Indian Journal of Palliative Care.
References
- Davison SN, Levin A, Moss AH, Jha V, Brown EA, Brennan F, et al. Executive summary of the KDIGO controversies conference on supportive care in chronic kidney disease: Developing a roadmap to improving quality care. Kidney Int. 2015;88:447–59.
- Galla JH. The renal physicians association and the American Society of Nephrology: Clinical practice guideline on shared decision-making in the appropriate initiation of and withdrawal from dialysis. J Am Soc Nephrol. 2000;11:1340–2.
- Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: Global dimension and perspectives. Lancet. 2013;382:260–72.
- Dare AJ, Fu SH, Patra J, Rodriguez PS, Thakur JS, Jha P, et al. Renal failure deaths and their risk factors in India 2001-13: Nationally representative estimates from the million death study. Lancet Glob Health. 2017;5:e89–95.
- Jha V. ESRD burden in South Asia: The challenges we are facing. Clin Nephrol. 2015;83:7–10.
- Shaikh M, Woodward M, John O, Bassi A, Jan S, Sahay M, et al. Utilization, costs, and outcomes for patients receiving publicly funded hemodialysis in India. Kidney Int. 2018;94:440–5.
- Kaur G, Prinja S, Ramachandran R, Malhotra P, Gupta KL, Jha V. Cost of hemodialysis in a public sector tertiary hospital of India. Clin Kidney J. 2018;11:726–33.
- Ashuntantang G, Osafo C, Olowu WA, Arogundade F, Niang A, Porter J, et al. Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: A systematic review. Lancet Glob Health. 2017;5:e408–17.
- Davison SN. Facilitating advance care planning for patients with end-stage renal disease: The patient perspective. Clin J Am Soc Nephrol. 2006;1:1023–8.
- Royal College of Physicians. London: Royal College of Physicians; 2009. Advance Care Planning. Concise Guidanceto Good Practice Series. Available from: .
- Detering KM, Silveira MJ. Arnold RM, Savarese DM, editors. Advance care planning and advance directives. 2018. Available from: UpToDate.
- Mullick A, Martin J, Sallnow L. An introduction to advance care planning in practice. BMJ. 2013;347:f6064.
- Combs SA. Working toward more effective advance care planning in patients with ESRD. Clin J Am Soc Nephrol. 2016;11:2107–9.
- Song MK, Ward SE, Fine JP, Hanson LC, Lin FC, Hladik GA, et al. Advance care planning and end-of-life decision making in dialysis: A randomized controlled trial targeting patients and their surrogates. Am J Kidney Dis. 2015;66:813–22.
Source: PubMed