Dr Kathryn Ducharlet1,2, Dr Dov Degen1, Ms Lisa Colquhoun1, Ms Dao Nguyen1, Ms Samantha Brean3, Mr Eric Wang2, Ms Kelly Habjan3, Professor Lawrence P McMahon1,2
1Eastern Health, , Australia, 2Eastern Health Clinical School, Monash University, Box Hill, Australia, 3Eastern Health Advanced Care Planning Program, Wantirna, Australia
Biography:
Kathryn is a nephrologist at Eastern Health and is the clinical lead of CKD and Kidney Supportive Care services. She has completed a PhD (Uni Melb) in 2021 and continues an active and collaborative research and clinical interests in developing kidney supportive care and conservative kidney management.
Aim:
To understand patients’ perspectives of Advance Care Planning (ACP) and recommend approaches to improve their engagement and experiences.
Background:
Discussions about future morbidities and end-of-life care are challenging in kidney care, with limited evidence to assist clinicians.
Method:
A qualitative study was performed at Eastern Health, Victoria. Participants were ≥70 years with chronic kidney disease, CKD (eGFR ≤20ml/min, or dialysis) and without significant cognitive impairment. After a 1-hour ACP discussion, patients were interviewed by independent renal clinicians. Interviews were audio-recorded, transcribed and analysed thematically.
Results:
Between December 2022 and April 2023, 47 patients participated (mean age 80 years; 57% male; 57% Australian-born; 81% English-speaking; 37% CKD; 47% satellite haemodialysis; 14% peritoneal dialysis.)
Overarching theme: ACP engagement was iterative and cumulative, influenced by health expectations, life experiences, and trusted relationships.
Subthemes:
1. Responses and engagement varied, shaped by their health expectations and past encounters with others who experienced illness and death.
2. ACP conversations had diverse roles and benefits depending on the level of engagement:
a. Low: elicited distress/difficulty coping with illness and mortality
b. Moderate: helped align health expectations and gather information
c. High: enabled reflection/expression of care preferences.
3. Trusted social networks (healthcare professionals, family, friends) provided support and played a key role in advancing ACP engagement.
Suggestions to improve ACP engagement:
1. Low: Increase psychological supports and focus conversations on reframing health expectations
2. Moderate: Provide ACP information and involve family/care-partners
3. High: Revisit ACP conversations as circumstances change over time.
Conclusion:
Patients’ perceptions of health, social and psychological factors inform ACP engagement. Clinicians should use targeted approaches adapted to patient engagement to enhance the ACP experiences
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