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O-93 Current practice and barriers to advance care planning in the australian and New Zealand nephrology setting: A national survey
  1. Josephine Clayton1,2,3,
  2. Tim Luckett4,5,
  3. Rachael L Morton6,7,
  4. Lucy Spencer3,
  5. William Silvester8,
  6. Marcus Sellars8,
  7. Karen Detering8,
  8. Allison Tong7,
  9. Phyllis Butow9 and
  10. Carol Pollock2,3
  1. 1HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Australia
  2. 2Sydney Medical School, University of Sydney, Sydney, Australia
  3. 3Royal North Shore Hospital, Sydney, Australia
  4. 4University of Technology Sydney, Sydney, Australia
  5. 5Improving Palliative Care Through Clinical Trials (ImPaCCT), Australia
  6. 6University of Oxford, Oxford, UK
  7. 7School of Public Health, University of Sydney, Sydney, Australia
  8. 8Austin Health, Melbourne, Australia
  9. 9School of Psychology, University of Sydney, Australia

Abstract

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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