Background Although recent clinical practice guidelines have highlighted the importance of advance care planning (ACP) for improving end-of-life care for people with chronic kidney disease (CKD), ACP can be complex and emotionally challenging for patients and providers, which may explain the limited uptake of ACP in renal settings.
Aim To describe the perspectives and experiences of healthcare providers who have facilitated ACP for patients with CKD.
Methods Face-to-face and telephone semi-structured interviews were conducted with nephrologists, nephrology nurses, nephrology social workers and dedicated nephrology ACP facilitators purposively sampled from all Australian states/territories. Data were analysed using grounded theory and thematic analysis.
Results Based on 10 interviews conducted to date, we identified four themes: embedding ACP into practice (availability of resources and materials, gaining competence, and perceptible value of ACP in practice); patient-focused ACP (understanding individual contexts, readiness and preparedness to discuss ACP and flexibility of patient decisions over time); comfort with ACP (patient’s stage of illness and age, perceived appropriateness and previous exposure to ACP); and enacting patient wishes (availability of ACP documents, clarity of documented wishes and competing agendas).
Discussion Healthcare providers who have participated in ACP for patients with CKD perceive ACP as important for patient care in supporting informed and respected choices. However, ACP can be complex and difficult to integrate in routine practice because of limited support to facilitate this process.
Conclusion Strategies are needed to facilitate the process of integrating ACP in the clinical care of patients with CKD.
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