Advance care planning in chronic kidney disease: A survey of current practice in Australia

Tim Luckett; Lucy Spencer; Rachael L Morton; Carol A Pollock; Lawrence Lam; William Silvester; Marcus Sellars; Karen M Detering; Phyllis N Butow; Allison Tong; Josephine M Clayton

doi:10.1111/nep.12743

Advance care planning in chronic kidney disease: A survey of current practice in Australia

Nephrology (Carlton). 2017 Feb;22(2):139-149. doi: 10.1111/nep.12743.

Authors

Tim Luckett^{1

2}, Lucy Spencer³, Rachael L Morton⁴, Carol A Pollock^{3

5}, Lawrence Lam², William Silvester⁶, Marcus Sellars^{5

6}, Karen M Detering⁶, Phyllis N Butow⁷, Allison Tong⁸, Josephine M Clayton^{1

5

9}

Affiliations

¹ Improving Palliative Care through Clinical Trials (ImPaCCT) New South Wales, New South Wales, Australia.
² Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia.
³ Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
⁴ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.
⁵ Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Respecting Patient Choices, Austin Health, Melbourne, Victoria, Australia.
⁷ School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.
⁸ School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
⁹ HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Sydney, New South Wales.

PMID: 26860214
DOI: 10.1111/nep.12743

Abstract

Aim: Advance care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice and identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches.

Methods: An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future.

Results: A total of 375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%) with 54% indicated that ACP at their workplace was performed ad hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (odds ratio (OR) 4.96, 95% confidence intervals (CI) 1.74-14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38-49.79).

Conclusion: Advance care planning in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multidisciplinary approach with a gradient of ACP expertise is also recommended.

Keywords: advance care planning; chronic kidney disease; conservative care; current practice; health professional view.

MeSH terms

Adult
Advance Care Planning / trends*
Attitude of Health Personnel
Attitude to Death
Australia
Cross-Sectional Studies
Education, Medical, Continuing
Female
Health Care Surveys
Health Knowledge, Attitudes, Practice
Humans
Inservice Training
Linear Models
Logistic Models
Male
Middle Aged
Multivariate Analysis
Nephrology / education
Nephrology / trends*
Odds Ratio
Patient Education as Topic / trends
Physician-Patient Relations
Practice Patterns, Physicians' / trends*
Professional-Family Relations
Renal Insufficiency, Chronic / diagnosis
Renal Insufficiency, Chronic / mortality
Renal Insufficiency, Chronic / therapy*