Background Recent guidelines emphasise the need to improve advance care planning (ACP) for patients with chronic kidney disease (CKD). Little is known about current ACP practice in the Australian/New Zealand nephrology setting.
Aim To describe current practice and barriers to ACP from the perspective of Australian/New Zealand nephrology health professionals.
Methods A cross-sectional survey was administered online to nephrology nurses, nephrologists and social workers. Invitations were circulated via peak bodies, national conferences and the research team’s networks.
Results 417 renal clinicians participated from >135 renal units; 57% indicated that ACP was done in their workplace on an ad-hoc basis, 21% that there was a formal program, 14% that ACP hardly ever occurred, and 6% were unsure. Sixty-one percent reported that ACP was done poorly, 32% well, and 7% were unsure. Perceived barriers to ACP most commonly included patient/family discomfort, difficulty involving families and lack of clinician expertise (83% each), lack of clinician time (82%), health professional discomfort (72%), cultural/language barriers (65%), environmental problems such as lack of space (61%) and lack of policy/procedures (60%). Whilst discouragement from colleagues or managers was identified as a barrier in only 20% of cases, comments emphasised the gate-keeping role played by nephrologists.
Discussion ACP in Australian/New Zealand nephrology may be limited due to health system, provider and patient related barriers. Given the volunteer effect associated with online surveys, our study probably underestimates the need for ACP support in this setting.
Conclusion Targeted interventions are needed to improve ACP in Australian/New Zealand nephrology settings.
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