IMPLEMENTATION OF INFORMED CONSENT FOR DIALYSIS – A SINGLE CENTRE EXPERIENCE
Dr Krupa Shah1, Dr Daniel O’Hara1,2, Dr Sarah Roxburgh1
1Royal North Shore Hospital, , Australia, 2NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, 2050
Aim: To describe the process and challenges of dialysis consent form development in our district.
Background: International consensus guidelines recommend that dialysis, as an intensive treatment with significant risks, requires informed written consent completed by a senior clinician to comply with medicolegal and ethical standards. This need is most striking amongst the rising proportion of older, frailer, and more co-morbid patients with advanced kidney disease, for whom dialysis risks may outweigh benefits. Despite this, rates of consent completion remain low.
Methods: Our unit developed standardised haemodialysis and peritoneal dialysis consent forms through review of the literature, comparison to existing forms at other sites, iterative drafting with multidisciplinary stakeholder input including patients, and input from the ATSI Health service, the Medicolegal Department and the Forms Committee.
Results: 3 years after development initiation, the district-wide forms were finalised in August 2023 and published on the district intranet, the departmental share drive, and as paper copies. The two-page forms include discussion of treatment options, treatment risks, lifestyle and diet changes, data collection including ANZDATA, the option of future withdrawal from dialysis, and the offer of arranging an Advanced Care Directive. The department identified consent for those newly initiating dialysis as the primary implementation priority. Key strategies to improve uptake included providing consent forms at chronic kidney disease education clinic for patients to read and consider, using dedicated clinic appointments to facilitate consent discussions, and having a central staff member monitoring consent rates and prompting clinician completion.
Conclusions: Dialysis consent form development and implementation is complex and time-consuming, but is a major priority to provide safe and appropriate care. Success resulted from concerted effort by a multidisciplinary team.