UNDERSTANDING WHY PATIENTS WITH ADVANCED KIDNEY DISEASE ARE NOT READY TO ENGAGE IN ADVANCE CARE PLANNING
Kathryn Ducharlet1, Dov Degen1, Lisa Colquhoun1, Dao Nguyen1, Leeroy William1, Sam Brean1, Kelly Habjan1, Lawrence McMahon1 1Eastern Health, Box Hill, VIC, Australia
Abstract
Aim
To explore why older people with advanced kidney disease do not want to participate in advance care planning discussions.
Background
Conversations about future treatment decision making, serious illness and end-of-life care in kidney care are essential, however, no consensus or systematic approach is established with significant challenges and limitations described in practice. Exploration and understanding of barriers to patient engagement can inform future approaches to facilitate these discussions between patients and clinicians.
Methods
Between December 2022 and April 2023, a qualitative study comprised interviews with older people (>70 years) with advanced kidney disease (eGFR<20ml/min and dialysis) asking them about barriers to having conversations about future treatment planning and end-of-life care. A thematic analysis of transcribed results was undertaken using a phenomenological approach.
Results
Of the 66 patients approached, 44 enrolled (37 agreed to participate in future treatment planning, 7 agreed to explain why they did not want to participate. Of the 7 people interviewed, 4 were on dialysis, 3 had chronic kidney disease, 86% were men, average age 83 years, with a wide range of cultural backgrounds.
Preliminary analysis of transcribed interviews identified the following themes:
1.Perceived cultural and physical barriers to communication.
2.Coping strategies focused on living in the present.
3.Differing perceptions of the utility of end-of-life discussions.
4.Distress and fear at the prospect of serious illness or death.
Conclusions
These findings highlight the importance of psychologically safe, culturally and time sensitive communication to address the barriers to engage patients. Additional psychosocial supports would help individuals who perceive future deterioration in health as distressing to aid progression of these important discussions
Biography
Dr Kathryn Ducharlet is a renal physician the clinical lead of CKD and Kidney Supportive Care at Eastern Health. She has interests in symptom management, chronic kidney disease, dialysis and bioethics. Dr Ducharlet completed her medical degree and PhD at the University of Melbourne. She is the co-chair of the Kidney Supportive Care special interest group with Dr Frank Brennan which aims to improve quality of life for all people with advanced kidney disease in Australia and New Zealand.