Background There is increasing evidence of the benefits of advance care planning in patients with advanced kidney disease. End of life care in Advanced kidney disease (2009) A framework for implementation has also recommended their use.
Method Since 2008 in Calderdale a renal palliative care clinic has been established. All conservative care patients (not for dialysis) are seen by a palliative care consultant providing an ideal opportunity for advance care planning. In October 2010, an advance care planning document was introduced within the trust and used within the clinic
Results From October 2010 to April 2011, 20 Patients were reviewed in the clinic (average age 82 years and average eGFR=13.8 (range 6.3-18.5) During this 6-month period, 5/20 patients had formally completed an advance care plan which had been circulated and 7/20 patients were in the process of completing an advance care plan. One patient had completed an advance decision to refuse treatment. Therefore 65% patients were actively involved in the process and all had involved a family member.
Conclusion The renal palliative care clinic is ideal for the integration of advance care planning for patients with advanced kidney disease as it allows the opportunity to develop a good relationship with the patient and their family. It supports the need for chronically ill patients to think about the future direction of their medical care, preparing them for death and gain a realistic understanding of the services available. Advance care planning does take time but can empower patients to achieve a sense of control and relieve the burden of decision making from relatives. Further evaluation of outcomes is important.
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